Healthcare Provider Details

I. General information

NPI: 1568806461
Provider Name (Legal Business Name): DAVID W HAUSWIRTH M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2013
Last Update Date: 06/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6350 FRANTZ RD
DUBLIN OH
43017-1382
US

IV. Provider business mailing address

5877 CLEVELAND AVE
COLUMBUS OH
43231-2859
US

V. Phone/Fax

Practice location:
  • Phone: 614-766-4903
  • Fax: 614-766-4945
Mailing address:
  • Phone: 614-891-0550
  • Fax: 614-891-0429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number35079319
License Number StateOH

VIII. Authorized Official

Name: DAVID W HAUSWIRTH
Title or Position: OWNER
Credential: M.D.
Phone: 614-766-4903