Provider Demographics
NPI:1447239124
Name:DAWSON, KRISTEN E (MD)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:E
Last Name:DAWSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3780 MEDINA RD
Mailing Address - Street 2:STE. 200
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-9311
Mailing Address - Country:US
Mailing Address - Phone:330-722-3083
Mailing Address - Fax:330-725-5043
Practice Address - Street 1:3780 MEDINA RD
Practice Address - Street 2:STE. 200
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-9311
Practice Address - Country:US
Practice Address - Phone:330-722-3083
Practice Address - Fax:330-725-5043
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-079129E246ZS0410X
OH35079129208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4057394OtherMEDICARE ID
OH4057397OtherMEDICARE ID
OH4057391OtherMEDICARE ID
OH2262215Medicaid
OH4057395OtherMEDICARE ID
OH4057392OtherMEDICARE ID
OH4057392OtherMEDICARE ID