Healthcare Provider Details

I. General information

NPI: 1710289293
Provider Name (Legal Business Name): PREMIER ALLERGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2010
Last Update Date: 08/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 PERIMETER DR
DUBLIN OH
43016-8461
US

IV. Provider business mailing address

6565 PERIMETER DR
DUBLIN OH
43016-8461
US

V. Phone/Fax

Practice location:
  • Phone: 614-328-9927
  • Fax: 614-389-3727
Mailing address:
  • Phone: 614-328-9927
  • Fax: 614-389-3727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number096318
License Number StateOH

VIII. Authorized Official

Name: DR. SUMMIT S SHAH
Title or Position: PRESIDENT, CEO
Credential: MD, FAAAAI
Phone: 614-328-9927