Provider Demographics
NPI:1558484386
Name:OHIO VALLEY PLASTIC SURGERY
Entity Type:Organization
Organization Name:OHIO VALLEY PLASTIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:DELLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-926-1123
Mailing Address - Street 1:1320 CORPORATE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-4442
Mailing Address - Country:US
Mailing Address - Phone:330-650-0607
Mailing Address - Fax:330-650-0533
Practice Address - Street 1:1320 CORPORATE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-4442
Practice Address - Country:US
Practice Address - Phone:330-650-0607
Practice Address - Fax:330-650-0533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-08
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH340057272086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHOH9340991Medicare PIN