Provider Demographics
NPI:1841213451
Name:MCFADDEN, DWIGHT JULIUS III (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:DWIGHT
Middle Name:JULIUS
Last Name:MCFADDEN
Suffix:III
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 COMMERCIAL AVE SW
Mailing Address - Street 2:
Mailing Address - City:NEW PHILADELPHIA
Mailing Address - State:OH
Mailing Address - Zip Code:44663-9367
Mailing Address - Country:US
Mailing Address - Phone:330-343-7605
Mailing Address - Fax:330-343-3542
Practice Address - Street 1:716 COMMERCIAL AVE SW
Practice Address - Street 2:
Practice Address - City:NEW PHILADELPHIA
Practice Address - State:OH
Practice Address - Zip Code:44663-9367
Practice Address - Country:US
Practice Address - Phone:330-343-7605
Practice Address - Fax:330-343-3542
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35082662207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2424808Medicaid
OH2424808Medicaid
OHH43866Medicare UPIN