Healthcare Provider Details

I. General information

NPI: 1417983156
Provider Name (Legal Business Name): ERIC T OVERDORF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 N EWING ST #204
LANCASTER OH
43130-3382
US

IV. Provider business mailing address

1155 E MAIN ST
LANCASTER OH
43130-4056
US

V. Phone/Fax

Practice location:
  • Phone: 740-689-6594
  • Fax:
Mailing address:
  • Phone: 740-277-6237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01095091A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35092234
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: