Healthcare Provider Details

I. General information

NPI: 1033382411
Provider Name (Legal Business Name): DEREK CODY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2008
Last Update Date: 12/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3925 EMBASSY PARKWAY SUITE 300
AKRON OH
44333
US

IV. Provider business mailing address

3925 EMBASSY PARKWAY SUITE 300
AKRON OH
44333
US

V. Phone/Fax

Practice location:
  • Phone: 330-668-4065
  • Fax: 330-668-4082
Mailing address:
  • Phone: 330-668-4065
  • Fax: 330-668-4082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number35.128544
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: