Provider Demographics
NPI:1477555233
Name:DENGEL, FREDRICH (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDRICH
Middle Name:
Last Name:DENGEL
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 1:1720 COOPER FOSTER PARK RD W
Mailing Address - Street 2:SUITE B
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-4200
Mailing Address - Country:US
Mailing Address - Phone:440-989-4480
Mailing Address - Fax:440-989-4484
Practice Address - Street 1:1720 COOPER FOSTER PARK RD W
Practice Address - Street 2:SUITE B
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-4200
Practice Address - Country:US
Practice Address - Phone:440-989-4480
Practice Address - Fax:440-989-4484
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350455812085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH553842Medicaid
OH553842Medicaid
OHDE0575632Medicare ID - Type Unspecified