Provider Demographics
NPI:1659878221
Name:DAMRON, RAE
Entity Type:Individual
Prefix:
First Name:RAE
Middle Name:
Last Name:DAMRON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8585 WILDOMAR AVE
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-8559
Mailing Address - Country:US
Mailing Address - Phone:210-740-7890
Mailing Address - Fax:
Practice Address - Street 1:1435 E MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-2035
Practice Address - Country:US
Practice Address - Phone:614-364-7300
Practice Address - Fax:888-460-4717
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty