Provider Demographics
NPI:1568665891
Name:DERMATOLOGY ALLERGY GENERAL PHYSICIANS OF OHIO INC
Entity Type:Organization
Organization Name:DERMATOLOGY ALLERGY GENERAL PHYSICIANS OF OHIO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATION SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MCFARLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-233-0748
Mailing Address - Street 1:5212 BRANDT PIKE
Mailing Address - Street 2:SUITE A
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-6138
Mailing Address - Country:US
Mailing Address - Phone:937-233-0748
Mailing Address - Fax:937-233-6086
Practice Address - Street 1:37 NORTH PLAZA BOULEVARD
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-1759
Practice Address - Country:US
Practice Address - Phone:740-772-6600
Practice Address - Fax:740-775-9863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35 04 3565M207N00000X
OH35 05 8434M207R00000X
OH34003765F207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000011382OtherANTHEM PIN
OH485805933016OtherMEDICAL MUTUAL
OH9190161OtherPTAN
485805933027OtherMEDICAL MUTUAL PIN
OH368588672036OtherMMO PIN
OH000000011437OtherANTHEM PIN
OH000000011390OtherANTHEM PIN