Provider Demographics
NPI:1083665178
Name:OLSON, OSCAR C (MD)
Entity Type:Individual
Prefix:
First Name:OSCAR
Middle Name:C
Last Name:OLSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 BRIAR HILL RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:NORTH BALTIMORE
Mailing Address - State:OH
Mailing Address - Zip Code:45872-9504
Mailing Address - Country:US
Mailing Address - Phone:419-257-2992
Mailing Address - Fax:419-257-2112
Practice Address - Street 1:209 BRIAR HILL RD
Practice Address - Street 2:SUITE B
Practice Address - City:NORTH BALTIMORE
Practice Address - State:OH
Practice Address - Zip Code:45872-9504
Practice Address - Country:US
Practice Address - Phone:419-257-2992
Practice Address - Fax:419-257-2112
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35069222207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0221085Medicaid
G22616Medicare UPIN
OH0221085Medicaid