=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558484386
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OHIO VALLEY PLASTIC SURGERY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/08/2007
-----------------------------------------------------
Last Update Date | 03/12/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1320 CORPORATE DR SUITE 100
-----------------------------------------------------
City | HUDSON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44236-4442
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-650-0607
-----------------------------------------------------
Fax | 330-650-0533
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1320 CORPORATE DR SUITE 100
-----------------------------------------------------
City | HUDSON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44236-4442
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-650-0607
-----------------------------------------------------
Fax | 330-650-0533
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. DAVID BRIAN DELLINGER
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 330-926-1123
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2086S0122X
-----------------------------------------------------
Taxonomy Name | Plastic and Reconstructive Surgery Physician
-----------------------------------------------------
License Number | 34005727
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------