Provider Demographics
NPI:1619010535
Name:CENTRAL OHIO NEUROLOGY INC
Entity Type:Organization
Organization Name:CENTRAL OHIO NEUROLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:J
Authorized Official - Last Name:BADDOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-756-6990
Mailing Address - Street 1:370 CLINE AVE
Mailing Address - Street 2:STE C5
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-1057
Mailing Address - Country:US
Mailing Address - Phone:419-756-6990
Mailing Address - Fax:419-756-0944
Practice Address - Street 1:370 CLINE AVENUE
Practice Address - Street 2:STE C5
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-1057
Practice Address - Country:US
Practice Address - Phone:419-756-6990
Practice Address - Fax:419-756-0944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2877801Medicaid
OH606176800OtherDEPT OF LABOR ID
OH30022664OtherRAILROAD MEDICARE
OH000000182209OtherANTHEM
OH30022664OtherRAILROAD MEDICARE
OH=========001OtherMEDICAL MUTUAL
OH=========001OtherMEDICAL MUTUAL