Provider Demographics
NPI:1568806461
Name:DAVID W HAUSWIRTH M.D.
Entity Type:Organization
Organization Name:DAVID W HAUSWIRTH M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:HAUSWIRTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-766-4903
Mailing Address - Street 1:5877 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231-2859
Mailing Address - Country:US
Mailing Address - Phone:614-891-0550
Mailing Address - Fax:614-891-0429
Practice Address - Street 1:6350 FRANTZ RD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-1382
Practice Address - Country:US
Practice Address - Phone:614-766-4903
Practice Address - Fax:614-766-4945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-22
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35079319207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH197901Medicare PIN