Healthcare Provider Details

I. General information

NPI: 1982107835
Provider Name (Legal Business Name): DYLAN RUDY M.ED
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2018
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4664 LARWELL DR
COLUMBUS OH
43220-3621
US

IV. Provider business mailing address

4664 LARWELL DR
COLUMBUS OH
43220-3621
US

V. Phone/Fax

Practice location:
  • Phone: 614-487-7805
  • Fax:
Mailing address:
  • Phone: 614-487-7805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-19-34971
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: