Provider Demographics
NPI:1932117579
Name:HEARNE, DEAN W (MD)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:W
Last Name:HEARNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5720 BLAZER PKWY
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-3566
Mailing Address - Country:US
Mailing Address - Phone:614-761-1151
Mailing Address - Fax:614-761-4893
Practice Address - Street 1:1933 OHIO DR
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-4835
Practice Address - Country:US
Practice Address - Phone:614-277-9530
Practice Address - Fax:614-277-2227
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35065121207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0145373Medicaid
OH0145373Medicaid
OHHE0737876Medicare UPIN