Organization
ALLERGY AND ASTHMA CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VIDYASHANKAR B REVAN M.D. (MD / PRESIDENT)
(937) 655-9179
Entity
Organization
Contact information
Practice address
110 FAIRWAY DR, SUITE # 2, WILMINGTON, OH 45177-8756
(937) 655-9179
(937) 655-9139
Mailing address
110 FAIRWAY DR, SUITE # 2, WILMINGTON, OH 45177-8756
(937) 655-9179
(937) 655-9139
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
35080833
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000237118
BLUECROSS AND BLUESHIELD
—
01
—
0200482
UNITED HEALTH CARE
—
05
—
2321660
—
OH
01
—
D80833
HUMANA / CHOICE CARE ID
—
01
—
DD 2704
RAILROAD MEDICARE ID #
—
Enumeration date
10/06/2006
Last updated
08/22/2020
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