Provider Demographics
NPI:1790825925
Name:BUCKEYE ALLERGY
Entity Type:Organization
Organization Name:BUCKEYE ALLERGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-891-0550
Mailing Address - Street 1:PO BOX 183027 DEPT LB-05
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43218-3027
Mailing Address - Country:US
Mailing Address - Phone:614-766-4903
Mailing Address - Fax:
Practice Address - Street 1:5877 CLEVELAND AVENUE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-2859
Practice Address - Country:US
Practice Address - Phone:614-891-0550
Practice Address - Fax:614-891-0429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2604346Medicaid
A80410Medicare UPIN
OH9353081Medicare PIN