Active NPI
Marylynn Broderick Herchline, MD
- Pediatric Adolescent Medicine Physician
- Dayton, OH
National Provider Identifier
1295811412
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Adolescent Medicine Physician
- License
- 35057027
- Practice address
- 9000 North Main Street
Suite 332
Dayton, OH 45415-1185 - Phone
- (937) 832-7337
- Fax
- (937) 832-4817
- NPI assigned
- Oct 31, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Adolescent Medicine Physician | 2080A0000X | 35057027 | OH | Primary |
Addresses
Primary practice location
9000 North Main Street
Suite 332
Dayton, OH 45415-1185
Mailing address
9000 North Main Street
Suite 332
Dayton, OH 45415-1185
Phone (937) 832-7337
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1220651 | Other | UNITED HEALTHCARE | |
| 0709602 | Other | BUREAU FOR CHILDREN WITH | |
| 311627276032 | Other | CARESOURCE | |
| 0709602 | Medicaid | OH | |
| 1220651 | Other | AETNA | |
| 000000037311 | Other | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35057027 | OH | MD | Pediatric Adolescent Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162252800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1295811412",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9000 NORTH MAIN STREET",
"address_2": "SUITE 332",
"city": "DAYTON",
"state": "OH",
"postal_code": "454151185",
"telephone_number": "937-832-7337",
"fax_number": "937-832-4817"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9000 NORTH MAIN STREET",
"address_2": "SUITE 332",
"city": "DAYTON",
"state": "OH",
"postal_code": "454151185",
"telephone_number": "937-832-7337",
"fax_number": "937-832-4817"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HERCHLINE",
"first_name": "MARYLYNN",
"middle_name": "BRODERICK",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-31",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2080A0000X",
"taxonomy_group": "",
"desc": "Pediatrics, Adolescent Medicine",
"state": "OH",
"license": "35057027",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "1220651",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BUREAU FOR CHILDREN WITH",
"identifier": "0709602",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CARESOURCE",
"identifier": "311627276032",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0709602",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "1220651",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "000000037311",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Dayton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.