Healthcare Provider Details

I. General information

NPI: 1851378780
Provider Name (Legal Business Name): HILARION WORONZOFF-DASHKOFF
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 05/19/2020
Certification Date: 05/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

568 S CLEVELAND AVE
WESTERVILLE OH
43081-8970
US

IV. Provider business mailing address

568 S CLEVELAND AVE
WESTERVILLE OH
43081-8970
US

V. Phone/Fax

Practice location:
  • Phone: 614-895-3344
  • Fax: 614-895-3795
Mailing address:
  • Phone: 614-895-3344
  • Fax: 614-895-3795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number35.138929
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: