Individual
EDNA J DYCOCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
64979 OLD TWENTY ON ROAD, CAMBRIDGE, OH 43725-9619
(740) 432-6628
(740) 432-5531
Mailing address
64979 OLD TWENTY ON ROAD, CAMBRIDGE, OH 43725-9619
(740) 432-6628
(740) 432-5531
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
129969
NY
208000000X
Pediatrics Physician
Primary
35056228
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000153673
ANTHEM
—
05
—
0803885
—
OH
01
—
1001723
AETNA
—
01
—
1200145
UNITED HEALTHCARE
—
01
—
C0006228
HEALTH PLAN
—
Enumeration date
10/25/2006
Last updated
07/08/2007
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