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General NPI Number Information
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NPI Number | 1932170834
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Entity Type | Organization
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Legal Business Name | NEURODEVELOPMENTAL CENTER OF NORTHWEST OHIO
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Dates
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Enumeration Date | 01/30/2006
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Last Update Date | 10/11/2011
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Provider Practice Location Address
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Address Line | 28442 E RIVER RD SUITE 203
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City | PERRYSBURG
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State | OH
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Zip | 43551-2858
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Country | US
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Telephone | 419-874-8447
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Fax | 419-874-8793
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Provider Business Mailing Address
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Address Line | 28442 E RIVER RD SUITE 203
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City | PERRYSBURG
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State | OH
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Zip | 43551-2858
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Country | US
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Telephone | 419-874-8447
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Fax | 419-874-8793
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Authorized Official
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Title or Position | PRESIDENT PHYSICIAN
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Name | DONALD IAN CAMERON
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Credential | M.D.
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Telephone | 419-874-8447
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 35047115C
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License Number State | OH
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