Healthcare Provider Details

I. General information

NPI: 1598798803
Provider Name (Legal Business Name): DAYTON CARDIAC ELECTROPHYSIOLOGY ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 PHILADELPHIA DR SUITE 648
DAYTON OH
45406-1840
US

IV. Provider business mailing address

2200 PHILADELPHIA DR SUITE 648
DAYTON OH
45406-1840
US

V. Phone/Fax

Practice location:
  • Phone: 937-275-2322
  • Fax: 937-275-2406
Mailing address:
  • Phone: 937-275-2322
  • Fax: 937-275-2406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number35057815
License Number StateOH

VIII. Authorized Official

Name: DR. ABDUL WASE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 937-275-2322