1447451661 NPI number — DERMATOLOGY ALLERGY GENERAL PHYSICIANS OF OHIO INC

Table of content: (NPI 1447451661)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447451661 NPI number — DERMATOLOGY ALLERGY GENERAL PHYSICIANS OF OHIO INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DERMATOLOGY ALLERGY GENERAL PHYSICIANS OF OHIO INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447451661
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/05/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5212 BRANDT PIKE
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
HUBER HEIGHTS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45424-6138
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-233-0748
Provider Business Mailing Address Fax Number:
937-233-6086

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5212 BRANDT PIKE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
HUBER HEIGHTS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45424-6138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-233-0748
Provider Business Practice Location Address Fax Number:
937-233-6086
Provider Enumeration Date:
05/29/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MCFARLAND
Authorized Official First Name:
THERESA
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
CORPORATION SECRETARY
Authorized Official Telephone Number:
937-233-0748

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  35043565M , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: 35058434M , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0105X , with the licence number: 34003765 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 368588672011 . This is a "MMO PIN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000011389 . This is a "ANTHEM PIN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000011437 . This is a "ANTHEM PIN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000269197 . This is a "ANTHEM PIN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 9190162 . This is a "PTAN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 394601220014 . This is a "MEDICAL MUTUAL PIN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 485805933016 . This is a "MMO PIN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".