=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164480851
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NOEL N EBOH MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2006
-----------------------------------------------------
Last Update Date | 11/28/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1040 DELAWARE AVENUE
-----------------------------------------------------
City | MARION
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43301-1814
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-383-7950
-----------------------------------------------------
Fax | 740-383-7087
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | # L-3549
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43260-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-383-7927
-----------------------------------------------------
Fax | 740-383-7942
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207T00000X
-----------------------------------------------------
Taxonomy Name | Neurological Surgery Physician
-----------------------------------------------------
License Number | 35044038E
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------