Provider Demographics
NPI:1356661599
Name:ZIDRON, AMY MARIE (DO,PHD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:MARIE
Last Name:ZIDRON
Suffix:
Gender:F
Credentials:DO,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7527
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-0727
Mailing Address - Country:US
Mailing Address - Phone:614-544-6155
Mailing Address - Fax:614-544-6370
Practice Address - Street 1:75 HOSPITAL DR STE 350
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2867
Practice Address - Country:US
Practice Address - Phone:740-592-7040
Practice Address - Fax:740-592-7041
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH34011021208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program