Provider Demographics
NPI:1356083802
Name:MODERN ALLERGY, LLC
Entity Type:Organization
Organization Name:MODERN ALLERGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:HAYWARD
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:614-758-7600
Mailing Address - Street 1:3535 FISHINGER BLVD
Mailing Address - Street 2:STE. 280
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-7568
Mailing Address - Country:US
Mailing Address - Phone:614-758-7600
Mailing Address - Fax:614-758-7609
Practice Address - Street 1:3535 FISHINGER BLVD STE 280
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-7568
Practice Address - Country:US
Practice Address - Phone:614-758-7600
Practice Address - Fax:614-758-7609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-13
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty