Provider Demographics
NPI:1881875532
Name:SIMONSSON, DOROTHY (MD)
Entity type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:
Last Name:SIMONSSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 CHILDRENS DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-2664
Mailing Address - Country:US
Mailing Address - Phone:614-722-4950
Mailing Address - Fax:614-722-4966
Practice Address - Street 1:849 FAIRMONT AVENUE
Practice Address - Street 2:SUITE 100A
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-2600
Practice Address - Country:US
Practice Address - Phone:410-494-1369
Practice Address - Fax:410-494-2737
Is Sole Proprietor?:No
Enumeration Date:2007-11-23
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57013779208000000X
MDD80927208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0054264Medicaid