Healthcare Provider Details

I. General information

NPI: 1447239124
Provider Name (Legal Business Name): KRISTEN E DAWSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 12/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3780 MEDINA RD STE. 200
MEDINA OH
44256-9311
US

IV. Provider business mailing address

3780 MEDINA RD STE. 200
MEDINA OH
44256-9311
US

V. Phone/Fax

Practice location:
  • Phone: 330-722-3083
  • Fax: 330-725-5043
Mailing address:
  • Phone: 330-722-3083
  • Fax: 330-725-5043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number35-079129E
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35079129
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: