Healthcare Provider Details

I. General information

NPI: 1194173864
Provider Name (Legal Business Name): NISHANT DAGLI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2016
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1072 EAGLETON BLVD STE A
LONDON OH
43140-9195
US

IV. Provider business mailing address

PO BOX 7527
DUBLIN OH
43017-0727
US

V. Phone/Fax

Practice location:
  • Phone: 740-852-2568
  • Fax: 740-852-2583
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.138678
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: