MEDICARE: DEAN W. HEARNE 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
1	207N00000X	Dermatology Physician	35065121	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	:	1932117579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEAN W. HEARNE M.D.

Provider Business Mailing Address
First Line	:	5720 BLAZER PKWY
Second Line	:
City	:	DUBLIN
State	:	OH
Zip	:	43017-3566
Country	:	US
Telephone Number	:	614-761-1151
Fax Number	:	614-761-4893

Provider Business Practice Location Address
First Line	:	1933 OHIO DR
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-4835
Country	:	US
Telephone Number	:	614-277-9530
Fax Number	:	614-277-2227

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	03/10/2015

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