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NPI Code Detail

MEDICARE: DR. DAVID A PERDZOCK M.D.

MEDICARE: DR. DAVID A PERDZOCK M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207LP2900XPain Medicine (Anesthesiology) Physician35038578OH
2207V00000XObstetrics & Gynecology Physician35038578OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1114926391
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAVID A PERDZOCK M.D.
Provider Business Mailing Address
First Line : PO BOX 20452
Second Line : COA-CRED
City : COLUMBUS
State : OH
Zip : 43220-0452
Country : US
Telephone Number : 614-442-2406
Fax Number : 614-442-2410
Provider Business Practice Location Address
First Line : 500 S CLEVELAND AVE
Second Line :
City : WESTERVILLE
State : OH
Zip : 43081-8971
Country : US
Telephone Number : 614-898-6659
Fax Number : 614-898-8631
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2005
Last Update Date : 10/13/2014

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