Provider Demographics
NPI:1003841669
Name:DIABETES & ENDOCRINOLOGY ASSOCIATES OF STARK COUNTY INCORPORATED
Entity Type:Organization
Organization Name:DIABETES & ENDOCRINOLOGY ASSOCIATES OF STARK COUNTY INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARVIND
Authorized Official - Middle Name:Y
Authorized Official - Last Name:KRISHNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-493-0013
Mailing Address - Street 1:4565 DRESSLER RD NW
Mailing Address - Street 2:SUITE #111
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2579
Mailing Address - Country:US
Mailing Address - Phone:330-493-0013
Mailing Address - Fax:330-493-6973
Practice Address - Street 1:4565 DRESSLER RD NW
Practice Address - Street 2:SUITE #111
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2579
Practice Address - Country:US
Practice Address - Phone:330-493-0013
Practice Address - Fax:330-493-6973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0632622Medicaid
OHDI9921791Medicare ID - Type Unspecified