MARY WONDERLY MD LLC NPI 1912167750

NPI Information

  • NPI: 1912167750
  • Provider Name: MARY WONDERLY MD LLC
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Organization
  • Address: 2575 HAYES AVE STE 5
    FREMONT, OH
    ZIP 43420
  • Phone: (419) 332-3560

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NPI Details

MARY WONDERLY MD LLC is a family medicine in Fremont, OH. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. MARY WONDERLY MD LLC NPI is 1912167750. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

2575 HAYES AVE STE 5
FREMONT, OH
ZIP 43420-201
Phone: (419) 332-3560
Fax: (419) 332-3565

The provider's authorized official is Denise Kerlin .
The authorized official title is Office Manager and has the following contact phone number (419) 332-3560.

The enumeration date for this NPI number is 6/16/2008 and was last updated on 11/26/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily Medicine35-082561OHIOYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1H82535MEDICARE UPINOHIO
22825045MEDICAIDOHIO
39377821MEDICARE PINOHIO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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