Healthcare Provider Details

I. General information

NPI: 1205280625
Provider Name (Legal Business Name): ALICIA BOND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2016
Last Update Date: 03/22/2022
Certification Date: 03/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 STATE ROUTE 44 STE 203
ROOTSTOWN OH
44272-9733
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 330-325-3202
  • Fax: 833-606-1565
Mailing address:
  • Phone: 330-325-3202
  • Fax: 833-606-1565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.137631
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: