Provider Demographics
NPI:1851591887
Name:DERMATOLOGY ALLERGY GENERAL PHYSICIANS OF OHIO INC
Entity Type:Organization
Organization Name:DERMATOLOGY ALLERGY GENERAL PHYSICIANS OF OHIO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATION SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MCFARLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-233-0748
Mailing Address - Street 1:5212 BRANDT PIKE
Mailing Address - Street 2:SUITE A
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-6138
Mailing Address - Country:US
Mailing Address - Phone:937-233-0748
Mailing Address - Fax:937-233-6086
Practice Address - Street 1:300 PATRICK AVENUE
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:OH
Practice Address - Zip Code:43078-2339
Practice Address - Country:US
Practice Address - Phone:937-652-1257
Practice Address - Fax:937-484-7913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35043565M207N00000X
OH35058434M207R00000X
OH34003765M207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000011382OtherANTHEM PIN-N
OH368588672030OtherMMO PIN-N
OH36D0350348OtherCLIA
OH9190169OtherPTAN
OH485805933016OtherMMO PIN-P
OH000000011389OtherANTHEM PIN
OH394601220026OtherMMO PIN
OH000000011437OtherANTHEM PIN-F
OH485805933033OtherMMO PIN-F