Provider Demographics
NPI:1043083694
Name:DONE
Entity Type:Organization
Organization Name:DONE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/BUSINESS STAFF
Authorized Official - Prefix:
Authorized Official - First Name:CREDENTIALING
Authorized Official - Middle Name:
Authorized Official - Last Name:DEPARTMENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-291-5143
Mailing Address - Street 1:545 METRO PL S STE 100
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-5353
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:545 METRO PL S STE 100
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-5353
Practice Address - Country:US
Practice Address - Phone:888-291-5143
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-06
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH35C-000658OtherMD