MEDICARE: DOVER ORTHOPAEDIC CENTER, INC

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
1	207X00000X	Orthopaedic Surgery Physician	35-048418	OH

Other Identifiers

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

General Provider Information

NPI Number	:	1861502130
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOVER ORTHOPAEDIC CENTER, INC

Provider Business Mailing Address
First Line	:	205 HOSPITAL DR
Second Line	:
City	:	DOVER
State	:	OH
Zip	:	44622-2058
Country	:	US
Telephone Number	:	330-343-3335
Fax Number	:	330-364-5720

Provider Business Practice Location Address
First Line	:	205 HOSPITAL DR
Second Line	:
City	:	DOVER
State	:	OH
Zip	:	44622-2058
Country	:	US
Telephone Number	:	330-343-3335
Fax Number	:	330-364-5720

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SCOTT F HOLDER
Credential	:	MD
Telephone Number	:	330-343-3335

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	08/22/2020

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