MEDICARE: DERMATOLOGY ALLERGY GENERAL PHYSICIANS OF OHIO INC

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	207R00000X	Internal Medicine Physician	35 05 8434M	OH
2	207ZP0105X	Clinical Pathology/Laboratory Medicine Physician	34003765F	OH
3	207N00000X	Dermatology Physician	35 04 3565M	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	485805933022	OTHER	OH	MMO PIN
2	394601220019	OTHER	OH	MMO PIN
3	000000011383	OTHER	OH	ANTHEM PIN
4	000000066851	OTHER	OH	ANTHEM PIN
5	485805933016	OTHER	OH	MMO PIN
6	9190167	OTHER	OH	PTAN
7	000000011437	OTHER	OH	ANTHEM PIN
8	368588672019	OTHER	OH	MMO PIN

General Provider Information

NPI Number	:	1902009327
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DERMATOLOGY ALLERGY GENERAL PHYSICIANS OF OHIO INC

Provider Business Mailing Address
First Line	:	5212 BRANDT PIKE
Second Line	:	SUITE A
City	:	HUBER HEIGHTS
State	:	OH
Zip	:	45424-6138
Country	:	US
Telephone Number	:	937-233-0748
Fax Number	:

Provider Business Practice Location Address
First Line	:	1820 C STREET
Second Line	:
City	:	LIMA
State	:	OH
Zip	:	45804-1832
Country	:	US
Telephone Number	:	419-222-4559
Fax Number	:	419-222-4589

Authorized Official
Title or Position	:	CORPORATION SECRETARY
Name	:	MRS. THERESA LYNN MCFARLAND
Credential	:
Telephone Number	:	937-233-0748

Provider Enumeration Date	:	06/06/2007
Last Update Date	:	10/05/2009

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Directions to “DERMATOLOGY ALLERGY GENERAL PHYSICIANS OF OHIO INC ” Practice Location

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