1518966118 NPI number — DR. GARY L DIER MD

Table of content: DR. GARY L DIER MD (NPI 1518966118)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518966118 NPI number — DR. GARY L DIER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIER
Provider First Name:
GARY
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1518966118
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/21/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 E CAMPUS VIEW BLVD STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43235-8628
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-569-7782
Provider Business Mailing Address Fax Number:
330-596-7791

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 E STATE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALLIANCE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44601-4936
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-596-6000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  35087821 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 271141 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: MD042743E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085R0202X , with the licence number: 36172 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: P00152920 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 89136F6 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 136F6 . This is a "BC BS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 2714549 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: N36172 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 108514900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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