Organization
MARK DAVANZO MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK E. DAVANZO MD (MD/OWNER AUTHORIZED OFFICIAL)
(614) 898-5561
Entity
Organization
Contact information
Practice address
477 COOPER ROAD, SUITE 440, WESTERVILLE, OH 43081-8053
(614) 898-5520
(614) 898-5563
Mailing address
477 COOPER ROAD, SUITE 440, WESTERVILLE, OH 43081-8053
(614) 898-5520
(614) 898-5563
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
35042997
OH
208600000X
Surgery Physician
Primary
—
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DP3368
RR MEDICARE
OH
Enumeration date
12/22/2008
Last updated
02/18/2011
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