Provider Demographics
NPI:1558998948
Name:DILLON, ROSALIE (DO)
Entity Type:Individual
Prefix:
First Name:ROSALIE
Middle Name:
Last Name:DILLON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 AFRICA RD STE 220
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-9830
Mailing Address - Country:US
Mailing Address - Phone:614-882-2349
Mailing Address - Fax:614-882-9005
Practice Address - Street 1:625 AFRICA RD STE 220
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-9830
Practice Address - Country:US
Practice Address - Phone:614-882-2349
Practice Address - Fax:614-882-9005
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-25
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.015531207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0480447Medicaid