Provider Demographics
NPI:1942206875
Name:DULL, DAVID D (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:D
Last Name:DULL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4442 LOGAN WAY
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-1739
Mailing Address - Country:US
Mailing Address - Phone:330-759-0904
Mailing Address - Fax:330-759-2201
Practice Address - Street 1:4442 LOGAN WAY
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-1739
Practice Address - Country:US
Practice Address - Phone:330-759-0904
Practice Address - Fax:330-759-2201
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-001383213EP1101X, 213ER0200X, 213ES0000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0022979Medicaid
OH0197320001Medicare NSC
OH0022979Medicaid
OHT80305Medicare UPIN