Healthcare Provider Details

I. General information

NPI: 1598718991
Provider Name (Legal Business Name): MARIA T DEUNGRIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 06/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 S 18TH ST
COLUMBUS OH
43205-2654
US

IV. Provider business mailing address

555 S 18TH ST
COLUMBUS OH
43205-2654
US

V. Phone/Fax

Practice location:
  • Phone: 614-722-4559
  • Fax: 614-722-4559
Mailing address:
  • Phone: 614-722-4559
  • Fax: 614-722-4559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number35121486
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: