Provider Demographics
NPI:1043404932
Name:DYAR, THERESA A (DO)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:A
Last Name:DYAR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 N COLUMBUS ST STE 200
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-8186
Mailing Address - Country:US
Mailing Address - Phone:740-689-3627
Mailing Address - Fax:740-687-5898
Practice Address - Street 1:2405 N COLUMBUS ST STE 200
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-8186
Practice Address - Country:US
Practice Address - Phone:740-689-3627
Practice Address - Fax:740-687-5898
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.009958207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4298871Medicare PIN