Provider Demographics
NPI:1225112410
Name:MAGER, DARLENE A (DO)
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:A
Last Name:MAGER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 N BROAD ST
Mailing Address - Street 2:STE. 1
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9200
Mailing Address - Country:US
Mailing Address - Phone:330-533-3900
Mailing Address - Fax:330-533-8498
Practice Address - Street 1:545 N BROAD ST
Practice Address - Street 2:STE. 1
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-9200
Practice Address - Country:US
Practice Address - Phone:330-533-3900
Practice Address - Fax:330-533-8498
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-005925207L00000X
PA05010122L207L00000X
MI5101009972207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0996623Medicaid
PA15146304Medicaid
OHMA0772303Medicare ID - Type Unspecified
OH0996623Medicaid