Provider Demographics
NPI:1588766950
Name:TROWBRIDGE, MARY KATHRYN (DO)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KATHRYN
Last Name:TROWBRIDGE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:67 WEST HIGH STREET
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:OH
Mailing Address - Zip Code:43140-2131
Mailing Address - Country:US
Mailing Address - Phone:740-852-3171
Mailing Address - Fax:740-852-1589
Practice Address - Street 1:67 W HIGH ST
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:OH
Practice Address - Zip Code:43140-1074
Practice Address - Country:US
Practice Address - Phone:740-852-3171
Practice Address - Fax:740-852-1589
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH34-00-4851207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0759960Medicaid