Healthcare Provider Details

I. General information

NPI: 1215341326
Provider Name (Legal Business Name): DEAN J KERENICK D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

799 FARSON STREET EMERGENCY DEPARTMENT
BELPRE OH
45714
US

IV. Provider business mailing address

401 MATTHEW ST
MARIETTA OH
45750-1635
US

V. Phone/Fax

Practice location:
  • Phone: 740-568-5669
  • Fax: 740-568-5279
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number3212
License Number StateWV
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number34.013088
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: