Provider Demographics
NPI:1154307858
Name:GIAMMAR, DAVID R (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:GIAMMAR
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 1:477 COOPER RD STE 440
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-8055
Mailing Address - Country:US
Mailing Address - Phone:380-898-5561
Mailing Address - Fax:380-898-5563
Practice Address - Street 1:477 COOPER RD STE 440
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8055
Practice Address - Country:US
Practice Address - Phone:380-898-5561
Practice Address - Fax:380-898-5563
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301102844208C00000X, 208C00000X
OH35.077358208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2307631Medicaid
MI1154307858Medicaid
OHGI4070612Medicare ID - Type UnspecifiedEAST OFFICE
MI1154307858Medicaid
OH2307631Medicaid
OHH56268Medicare UPIN
OHGI4070613Medicare ID - Type UnspecifiedRIVERSIDE OFFICE