Provider Demographics
NPI:1659569382
Name:KING, GWYN ELANN (DO)
Entity Type:Individual
Prefix:DR
First Name:GWYN
Middle Name:ELANN
Last Name:KING
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:GWYN
Other - Middle Name:ELANN
Other - Last Name:FRAMBACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:7249 LIBERTY WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-1518
Mailing Address - Country:US
Mailing Address - Phone:513-770-3263
Mailing Address - Fax:937-293-5568
Practice Address - Street 1:7249 LIBERTY WAY STE 100
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-1518
Practice Address - Country:US
Practice Address - Phone:513-770-3263
Practice Address - Fax:937-293-5568
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.010052207N00000X
NY249624207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1659569382Medicaid
OH1659569382Medicaid