Provider Demographics
NPI:1750022802
Name:DICKINSON, ELIAS URBAN
Entity Type:Individual
Prefix:MR
First Name:ELIAS
Middle Name:URBAN
Last Name:DICKINSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3444 BEECHGROVE RD
Mailing Address - Street 2:
Mailing Address - City:MORAINE
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1102
Mailing Address - Country:US
Mailing Address - Phone:937-520-9755
Mailing Address - Fax:
Practice Address - Street 1:3444 BEECHGROVE RD
Practice Address - Street 2:
Practice Address - City:MORAINE
Practice Address - State:OH
Practice Address - Zip Code:45439-1102
Practice Address - Country:US
Practice Address - Phone:937-520-9755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health