Provider Demographics
NPI:1598767584
Name:DRAGASH, TERRY ALAN (DO)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:ALAN
Last Name:DRAGASH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 LAUREL LN
Mailing Address - Street 2:
Mailing Address - City:PATASKALA
Mailing Address - State:OH
Mailing Address - Zip Code:43062-8544
Mailing Address - Country:US
Mailing Address - Phone:740-964-2667
Mailing Address - Fax:
Practice Address - Street 1:2912 S HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-3616
Practice Address - Country:US
Practice Address - Phone:614-748-2000
Practice Address - Fax:614-748-3000
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34004340207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0665687Medicaid
9301621Medicare ID - Type Unspecified
OH0665687Medicaid