Healthcare Provider Details

I. General information

NPI: 1811199888
Provider Name (Legal Business Name): IAN LEE VALERIO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: IAN L. VALERIO M.D.

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 05/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 OLENTANGY RIVER RD STE 2140
COLUMBUS OH
43212-3153
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-8566
  • Fax: 614-293-3381
Mailing address:
  • Phone: 614-293-8566
  • Fax: 614-293-3381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number35123915
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberMT183681
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: