Healthcare Provider Details

I. General information

NPI: 1841461019
Provider Name (Legal Business Name): DEREN HUANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2008
Last Update Date: 03/20/2020
Certification Date: 03/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 MCMILLON DRIVE
NEWARK OH
43055
US

IV. Provider business mailing address

150 MCMILLON DRIVE
NEWARK OH
43055
US

V. Phone/Fax

Practice location:
  • Phone: 220-564-7985
  • Fax: 220-564-7986
Mailing address:
  • Phone: 220-564-7985
  • Fax: 220-564-7986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number35
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: