Provider Demographics
NPI:1932215217
Name:DORFMAN, PHILIP M (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:M
Last Name:DORFMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 ARCH ST
Mailing Address - Street 2:SUITE 240
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1437
Mailing Address - Country:US
Mailing Address - Phone:330-375-3226
Mailing Address - Fax:330-375-3229
Practice Address - Street 1:95 ARCH ST
Practice Address - Street 2:SUITE 240
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1437
Practice Address - Country:US
Practice Address - Phone:330-375-3226
Practice Address - Fax:330-375-3229
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35048101207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000137959OtherANTHEM
OH0532398OtherMEDICARE ID
OH341758848033OtherCARESOURCE
OH060023930OtherRR MEDICARE
OHQ017923AOtherHOMETOWN HEALTH PLAN
OH341494944AOtherSUMMA
OH0532391OtherMEDICARE ID
OH730329OtherCOMMUNITY HEALTH PLAN
OH0981559Medicaid
OH0532398OtherMEDICARE ID