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Organization
SYCAMORE INTERNAL MEDICINE AND WOMEN'S WELLNESS CENTER INC
Active
Organization
SYCAMORE INTERNAL MEDICINE AND WOMEN'S WELLNESS CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VIDA FARHANGI MD (PRESIDENT)
(937) 866-6655
Entity
Organization
Contact information
Practice address
4000 MIAMISBURG CENTERVILLE RD, SUITE 207, MIAMISBURG, OH 45342-3758
(937) 866-6655
(937) 866-6595
Mailing address
PO BOX 270, MIAMISBURG, OH 45343-0270
(937) 866-6655
(937) 866-6595
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
35-07-8961F
OH
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
35.092005
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000233015
ANTHEM
—
01
—
000000578348
ANTHEM
OH
01
—
0565421
CIGNA
OH
01
—
1851374615
RENDERING PROVIDER
OH
01
—
1851390983
RENDERING PROVIDER NPI
OH
05
—
2232873
—
OH
01
—
2472827
UNITED HEALTHCARE
OH
01
—
2678666
AETNA
OH
01
—
274966422004
MEDICAL MUTUAL OF OHIO
OH
01
—
6199428002
CIGNA
OH
01
—
7028685
AETNA
OH
01
—
76-00115
UNITED HEALTHCARE
—
01
—
D-78961
HUMANA
OH
01
—
DB6813
RAILROAD MEDICARE
OH
Enumeration date
02/13/2007
Last updated
11/03/2008
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