Healthcare Provider Details

I. General information

NPI: 1851322358
Provider Name (Legal Business Name): KARL A OHLY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 10/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 E. EIGHTH ST. SUITE 130
MARIETTA OH
45750
US

IV. Provider business mailing address

PO BOX 449
MARIETTA OH
45750-0449
US

V. Phone/Fax

Practice location:
  • Phone: 740-373-7197
  • Fax: 740-373-7198
Mailing address:
  • Phone: 740-374-4500
  • Fax: 740-374-5887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34008795
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: