1447239124 NPI number — KRISTEN E DAWSON M.D.

Table of content: KRISTEN E DAWSON M.D. (NPI 1447239124)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447239124 NPI number — KRISTEN E DAWSON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAWSON
Provider First Name:
KRISTEN
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1447239124
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3780 MEDINA RD
Provider Second Line Business Mailing Address:
STE. 200
Provider Business Mailing Address City Name:
MEDINA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44256-9311
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-722-3083
Provider Business Mailing Address Fax Number:
330-725-5043

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3780 MEDINA RD
Provider Second Line Business Practice Location Address:
STE. 200
Provider Business Practice Location Address City Name:
MEDINA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44256-9311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-722-3083
Provider Business Practice Location Address Fax Number:
330-725-5043
Provider Enumeration Date:
01/11/2006

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: 246ZS0410X , with the licence number:  35-079129E , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: 35079129 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4057394 . This is a "MEDICARE ID" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 4057397 . This is a "MEDICARE ID" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 4057391 . This is a "MEDICARE ID" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2262215 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4057395 . This is a "MEDICARE ID" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 4057392 . This is a "MEDICARE ID" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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