Provider Demographics
NPI:1235186214
Name:WARD, DENIS W (PHD)
Entity Type:Individual
Prefix:
First Name:DENIS
Middle Name:W
Last Name:WARD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 6TH ST SW
Mailing Address - Street 2:OHIO HOSPITAL BASED PHYSICIAN CORP
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44710
Mailing Address - Country:US
Mailing Address - Phone:330-363-7462
Mailing Address - Fax:330-363-7679
Practice Address - Street 1:2600 6TH ST SW
Practice Address - Street 2:OHIO HOSPITAL BASED PHYSICIAN CORP
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44710
Practice Address - Country:US
Practice Address - Phone:330-363-7462
Practice Address - Fax:330-363-7679
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4565103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0881667Medicaid
R72010Medicare UPIN
CP11811Medicare PIN
OHCP11812Medicare PIN