Healthcare Provider Details

I. General information

NPI: 1326028291
Provider Name (Legal Business Name): CAROL A. STRONG DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 03/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

196 STATE ROUTE 124
NEW VIENNA OH
45159-9552
US

IV. Provider business mailing address

196 STATE ROUTE 124
NEW VIENNA OH
45159-9552
US

V. Phone/Fax

Practice location:
  • Phone: 937-685-9187
  • Fax: 937-685-9187
Mailing address:
  • Phone: 937-685-9187
  • Fax: 937-685-9187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number36-00-3123
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: