Provider Demographics
NPI:1609694736
Name:SOMMERVILLE, MARLON
Entity type:Individual
Prefix:
First Name:MARLON
Middle Name:
Last Name:SOMMERVILLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1642 CYPRESS CT
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-1422
Mailing Address - Country:US
Mailing Address - Phone:330-775-4838
Mailing Address - Fax:
Practice Address - Street 1:90 S MAPLE ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44302-1629
Practice Address - Country:US
Practice Address - Phone:866-534-2639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator