Provider Demographics
NPI:1710289293
Name:PREMIER ALLERGY
Entity Type:Organization
Organization Name:PREMIER ALLERGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SUMMIT
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FAAAAI
Authorized Official - Phone:614-328-9927
Mailing Address - Street 1:6565 PERIMETER DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-8461
Mailing Address - Country:US
Mailing Address - Phone:614-328-9927
Mailing Address - Fax:614-389-3727
Practice Address - Street 1:6565 PERIMETER DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-8461
Practice Address - Country:US
Practice Address - Phone:614-328-9927
Practice Address - Fax:614-389-3727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-03
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH096318207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3115462Medicaid
9393491Medicare PIN