Provider Demographics
NPI:1871828863
Name:OLSON, DAVID M (DO)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:OLSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 W MAPLE ST STE 110
Mailing Address - Street 2:
Mailing Address - City:HARTVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44632-7601
Mailing Address - Country:US
Mailing Address - Phone:330-877-3616
Mailing Address - Fax:330-877-1783
Practice Address - Street 1:855 W MAPLE ST STE 110
Practice Address - Street 2:
Practice Address - City:HARTVILLE
Practice Address - State:OH
Practice Address - Zip Code:44632-7601
Practice Address - Country:US
Practice Address - Phone:330-877-3616
Practice Address - Fax:330-877-1783
Is Sole Proprietor?:No
Enumeration Date:2009-10-08
Last Update Date:2025-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH58-003267390200000X
OH34010510207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH098390Medicare PIN