MEDICARE: DR. DENNIS EVAN O'GRADY PSY.D.

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
1	103T00000X	Psychologist	3388	OH

General Provider Information

NPI Number	:	1811005879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENNIS EVAN O'GRADY PSY.D.

Provider Business Mailing Address
First Line	:	7085 CORPORATE WAY
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45459-4223
Country	:	US
Telephone Number	:	937-428-0724
Fax Number	:	937-428-0824

Provider Business Practice Location Address
First Line	:	7085 CORPORATE WAY
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45459-4223
Country	:	US
Telephone Number	:	937-428-0724
Fax Number	:	937-428-0824

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	09/07/2016

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