Healthcare Provider Details

I. General information

NPI: 1902009327
Provider Name (Legal Business Name): DERMATOLOGY ALLERGY GENERAL PHYSICIANS OF OHIO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 10/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 C STREET
LIMA OH
45804-1832
US

IV. Provider business mailing address

5212 BRANDT PIKE SUITE A
HUBER HEIGHTS OH
45424-6138
US

V. Phone/Fax

Practice location:
  • Phone: 419-222-4559
  • Fax: 419-222-4589
Mailing address:
  • Phone: 937-233-0748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number35 04 3565M
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35 05 8434M
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number34003765F
License Number StateOH

VIII. Authorized Official

Name: MRS. THERESA LYNN MCFARLAND
Title or Position: CORPORATION SECRETARY
Credential:
Phone: 937-233-0748