Provider Demographics
NPI:1114927977
Name:STEIN, DAGMAR (MD, PHD)
Entity Type:Individual
Prefix:
First Name:DAGMAR
Middle Name:
Last Name:STEIN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2142 N COVE BLVD
Mailing Address - Street 2:5-SOUTH, PEDIATICS
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3895
Mailing Address - Country:US
Mailing Address - Phone:419-291-7815
Mailing Address - Fax:419-291-6120
Practice Address - Street 1:2142 N COVE BLVD
Practice Address - Street 2:5-SOUTH, PEDIATICS
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3895
Practice Address - Country:US
Practice Address - Phone:419-291-7815
Practice Address - Fax:419-291-6120
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35070591208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000141187OtherANTHEM
OH830005376OtherRRMC
OH2083700OtherAETNA
OH2007321Medicaid
OH36-00165OtherUHC
MI4254252Medicaid
OH02261OtherPARAMOUNT
OH2083700OtherAETNA
OH2007321Medicaid