Healthcare Provider Details

I. General information

NPI: 1770920316
Provider Name (Legal Business Name): YALON AVNER DOLEV MD.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2013
Last Update Date: 05/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 OLENTANGY RIVER RD 4TH FLOOR
COLUMBUS OH
43212
US

IV. Provider business mailing address

915 OLENTANGY RIVER RD 4TH FLOOR
COLUMBUS OH
43212
US

V. Phone/Fax

Practice location:
  • Phone: 614-366-7927
  • Fax:
Mailing address:
  • Phone: 614-366-3687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberR14682
License Number StateZZ
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number35-121662
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number35-121662
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: