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General NPI Number Information
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NPI Number | 1689618118
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Entity Type | Individual
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Provider Name | MARK E DAVANZO MD
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Gender | Male
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Dates
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Enumeration Date | 06/15/2006
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Last Update Date | 03/28/2019
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Provider Practice Location Address
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Address Line | 477 COOPER RD SUITE 440
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City | WESTERVILLE
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State | OH
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Zip | 43081-8053
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Country | US
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Telephone | 380-898-5561
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Fax | 380-898-5563
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Provider Business Mailing Address
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Address Line | 477 COOPER RD SUITE 440
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City | WESTERVILLE
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State | OH
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Zip | 43081-8053
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Country | US
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Telephone | 380-898-5561
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Fax | 380-898-5563
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 35051847
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License Number State | OH
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