Provider Demographics
NPI:1679522015
Name:DAMASCUS FAMILY MEDICINE, INC.
Entity Type:Organization
Organization Name:DAMASCUS FAMILY MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DELIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HERZOG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-578-4040
Mailing Address - Street 1:200 BRADENTON AVE
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-7515
Mailing Address - Country:US
Mailing Address - Phone:614-793-1980
Mailing Address - Fax:614-793-1985
Practice Address - Street 1:388 DAMASCUS RD
Practice Address - Street 2:SUITE A
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-8507
Practice Address - Country:US
Practice Address - Phone:937-578-4040
Practice Address - Fax:937-587-2602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-06-5804207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2593162Medicaid
OH2593162Medicaid