1568467397 NPI number — DR. DENNIS FLYNN MD

Table of content: DR. DENNIS FLYNN MD (NPI 1568467397)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568467397 NPI number — DR. DENNIS FLYNN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLYNN
Provider First Name:
DENNIS
Provider Middle Name:
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:
1568467397
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 550
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANCASTER
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43130-0550
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-687-5164
Provider Business Mailing Address Fax Number:
740-654-1417

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6760 AVERY MUIRFIELD DR
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
DUBLIN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43017-1232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-791-9952
Provider Business Practice Location Address Fax Number:
614-791-9953
Provider Enumeration Date:
06/17/2005

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: 207Q00000X , with the licence number:  35-048544 , 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: 0584149 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com