1700846466 NPI number — DR. AVEN DAWN MALEC DO

Table of content: JOSEPHINE TURNER (NPI 1790565240)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700846466 NPI number — DR. AVEN DAWN MALEC DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MALEC
Provider First Name:
AVEN
Provider Middle Name:
DAWN
Provider Name Prefix Text:
DR.
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:
1700846466
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6300 WILSON MILLS RD
Provider Second Line Business Mailing Address:
W31
Provider Business Mailing Address City Name:
MAYFIELD VILLAGE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44143-2109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-893-1033
Provider Business Mailing Address Fax Number:
855-529-7659

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6300 WILSON MILLS RD
Provider Second Line Business Practice Location Address:
W31
Provider Business Practice Location Address City Name:
MAYFIELD VILLAGE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44143-2109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-893-1033
Provider Business Practice Location Address Fax Number:
855-529-7659
Provider Enumeration Date:
03/27/2006

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: 207Q00000X , with the licence number:  34-007967 , 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: 341425870042 . This is a "MEDICAL MUTUAL OF OHIO" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 264200000 . This is a "DEPT OF LABOR" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 6600162 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2472917 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 80507 . This is a "QUALCHOICE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000339430 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 264200000 . This is a "FEDERAL BLACK LUNG" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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