Provider Demographics
NPI:1417981077
Name:OLSON, DAN N (MD)
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:N
Last Name:OLSON
Suffix:
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 1:2600 STATE ROUTE 5
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44410-9393
Mailing Address - Country:US
Mailing Address - Phone:330-372-8800
Mailing Address - Fax:330-372-8999
Practice Address - Street 1:2600 STATE ROUTE 5
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:OH
Practice Address - Zip Code:44410-9393
Practice Address - Country:US
Practice Address - Phone:330-372-8800
Practice Address - Fax:330-372-8999
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35045552207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000243190OtherANTHEM BC/BS
OH400885OtherUNITED HEALTHCARE
OH78934OtherHEALTH ASSURANCE
OHJ45552OtherSUMMACARE
OHQ022608OtherHOMETOWN
OH0465527Medicaid
OH341341025039OtherCARESOURCE
OH0465527Medicaid
OH$$$$$$$$$003OtherMEDICAL MUTUAL OF OHIO
OH400885OtherUNITED HEALTHCARE
OHC02164Medicare UPIN
OH$$$$$$$$$OtherTRICARE/HEALTHNET