1558576876 NPI number — DANIELLE J CLEMMER DO

Table of content: DANIELLE J CLEMMER DO (NPI 1558576876)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558576876 NPI number — DANIELLE J CLEMMER DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLEMMER
Provider First Name:
DANIELLE
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1558576876
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3555 OLENTANGY RIVER RD
Provider Second Line Business Mailing Address:
SUITE 1080
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43214-3912
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-268-8164
Provider Business Mailing Address Fax Number:
614-268-8406

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3555 OLENTANGY RIVER RD
Provider Second Line Business Practice Location Address:
SUITE 1080
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-268-8164
Provider Business Practice Location Address Fax Number:
614-268-8406
Provider Enumeration Date:
05/11/2007

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: 208M00000X , with the licence number:  34.009238 , 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: 34.009238 , 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: 2840797 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com