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NPI Code Detail

MEDICARE: WAYDE D.H. DAZELLE MD, MS

MEDICARE: WAYDE D.H. DAZELLE MD, MS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician35.156193OH
2208000000XPediatrics Physician35.156193OH

General Provider Information

NPI Number : 1376245324
Entity Type Code : Individual
Provider Name (Legal Business Name) : WAYDE D.H. DAZELLE MD, MS
Provider Business Mailing Address
First Line : 1405 S HIGH ST
Second Line :
City : COLUMBUS
State : OH
Zip : 43207-1043
Country : US
Telephone Number : 614-355-9000
Fax Number : 614-355-9010
Provider Business Practice Location Address
First Line : 1405 S HIGH ST
Second Line :
City : COLUMBUS
State : OH
Zip : 43207-1043
Country : US
Telephone Number : 614-355-9000
Fax Number : 614-355-9010
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2023
Last Update Date : 06/03/2026

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