Provider Demographics
NPI:1740247816
Name:AGNESE, DOREEN M (MD)
Entity type:Individual
Prefix:
First Name:DOREEN
Middle Name:M
Last Name:AGNESE
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Gender:
Credentials:MD
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Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-4040
Mailing Address - Fax:614-293-3465
Practice Address - Street 1:1145 OLENTANGY RIVER RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-3117
Practice Address - Country:US
Practice Address - Phone:614-293-4040
Practice Address - Fax:614-293-3465
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2025-04-03
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Provider Licenses
StateLicense IDTaxonomies
OH35084548207SG0201X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2486920Medicaid
H13442Medicare UPIN
OHAG4135663Medicare PIN
OH2486920Medicaid