Healthcare Provider Details

I. General information

NPI: 1295823094
Provider Name (Legal Business Name): RICHARD JONAH FLAKSMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 05/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 DELAWARE AVE
MARION OH
43302-6416
US

IV. Provider business mailing address

DEPT L-3652
COLUMBUS OH
43260-0001
US

V. Phone/Fax

Practice location:
  • Phone: 740-383-7936
  • Fax: 740-375-8174
Mailing address:
  • Phone: 740-383-7927
  • Fax: 740-383-7942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number2004020465
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number35.038693
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: