Mary Wonderly MD LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

35-082561 Issued in OH

Legal business name

MARY WONDERLY MD LLC

Practice address

2575 Hayes Ave Ste 5
Fremont, OH 43420-5201

Phone

(419) 332-3560

Fax

(419) 332-3565

NPI assigned

Jun 16, 2008

Last updated

Nov 26, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Denise Kerlin

Title

Office Manager

Phone

(419) 332-3560

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1213574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1227657600000",
    "number": "1912167750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2575 HAYES AVE STE 5",
            "city": "FREMONT",
            "state": "OH",
            "postal_code": "434205201",
            "telephone_number": "419-332-3560",
            "fax_number": "419-332-3565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2575 HAYES AVE STE 5",
            "city": "FREMONT",
            "state": "OH",
            "postal_code": "434205201",
            "telephone_number": "419-332-3560",
            "fax_number": "419-332-3565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY WONDERLY MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-16",
        "last_updated": "2008-11-26",
        "status": "A",
        "authorized_official_last_name": "KERLIN",
        "authorized_official_first_name": "DENISE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "419-332-3560"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35-082561",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2825045",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Breann Majors, APRN, NP-C
• Zoie Lee D Marcotte
• Brittany Mares
• Jody Lynn Marez, LPN
• Margie a. Thomas
• Inge Marion Massie
• Margaret A Mathews, PT
• Mark A. Mathews, O.D.
• Clarissa Matthews, PCC, LPCC, LSW
• John M Mauric, D.O.

• Family Medicine Physician in Fremont, OH
• Providers in Fremont, OH by specialty
• Family Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.