Healthcare Provider Details

I. General information

NPI: 1467431569
Provider Name (Legal Business Name): DONALD AUGUST PELSOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 11/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W WENGER RD
ENGLEWOOD OH
45322
US

IV. Provider business mailing address

120 W WENGER RD
ENGLEWOOD OH
45322
US

V. Phone/Fax

Practice location:
  • Phone: 937-836-9921
  • Fax: 937-836-1298
Mailing address:
  • Phone: 937-836-9921
  • Fax: 937-836-1298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35 04 3249P
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0102335 IN
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: