Provider Demographics
NPI:1396953956
Name:OZA, AMISH S (MD)
Entity type:Individual
Prefix:
First Name:AMISH
Middle Name:S
Last Name:OZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1728 MARION WALDO RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-7457
Mailing Address - Country:US
Mailing Address - Phone:740-389-2297
Mailing Address - Fax:740-888-0004
Practice Address - Street 1:1728 MARION WALDO RD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-7457
Practice Address - Country:US
Practice Address - Phone:740-389-2297
Practice Address - Fax:740-888-0004
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.094647207QA0401X, 208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3005705Medicaid
OH3005705Medicaid