Provider Demographics
NPI:1740475813
Name:DYMENT, MACAIRA (DPM)
Entity type:Individual
Prefix:
First Name:MACAIRA
Middle Name:
Last Name:DYMENT
Suffix:
Gender:F
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:PO BOX 1554
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-6554
Mailing Address - Country:US
Mailing Address - Phone:614-864-9560
Mailing Address - Fax:614-864-9709
Practice Address - Street 1:9759 FAIRWAY BLVD
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-6947
Practice Address - Country:US
Practice Address - Phone:614-792-3668
Practice Address - Fax:614-792-7615
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-003549213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3067229Medicaid
OH4294441Medicare PIN