Provider Demographics
NPI:1922289198
Name:BUCKEYE ALLERGY
Entity Type:Organization
Organization Name:BUCKEYE ALLERGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:GARRY
Authorized Official - Middle Name:HARRY
Authorized Official - Last Name:RUPP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-891-0550
Mailing Address - Street 1:PO BOX 183017
Mailing Address - Street 2:DEPT LB 05
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43218-3027
Mailing Address - Country:US
Mailing Address - Phone:614-891-0550
Mailing Address - Fax:614-891-0429
Practice Address - Street 1:5877 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231
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:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9353081Medicare PIN
RU0400675Medicare PIN