Healthcare Provider Details

I. General information

NPI: 1295148260
Provider Name (Legal Business Name): SUMMER LEA BANZHAF DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2014
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 COLUMBUS RD STE 203
ATHENS OH
45701-1316
US

IV. Provider business mailing address

416 COLEGATE DR BLDG 3
MARIETTA OH
45750-9549
US

V. Phone/Fax

Practice location:
  • Phone: 740-331-6910
  • Fax: 740-331-6919
Mailing address:
  • Phone: 740-374-3526
  • Fax: 740-374-3165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34.013015
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: