Provider Demographics
NPI:1356304901
Name:DELL, JOHN C JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:DELL
Suffix:JR
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 1:3879 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:GALENA
Mailing Address - State:OH
Mailing Address - Zip Code:43021-9521
Mailing Address - Country:US
Mailing Address - Phone:740-965-9743
Mailing Address - Fax:
Practice Address - Street 1:3879 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:GALENA
Practice Address - State:OH
Practice Address - Zip Code:43021-9521
Practice Address - Country:US
Practice Address - Phone:740-965-9743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-047072207R00000X
TXF9359207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9842495OtherMEDICAID PROVIDER #
O003160OtherCHAMPUS PROVIDER #
OH12822OtherCARESOURCE PROVIDER #
297477OtherFED BLACK LUNG PROVIDER #
KY64934557OtherMEDICAID PROVIDER #
1463364OtherU.M.W.A. PROVIDER #
OH000000119166OtherANTHEM PROVIDER #
OH0598134Medicaid
11077419OtherRAILROAD MEDICARE #
OH0598134Medicaid
11077419OtherRAILROAD MEDICARE #