Organization
DERMATOLOGY ALLERGY GENERAL PHYSICIANS OF OHIO INC
Active
Organization
DERMATOLOGY ALLERGY GENERAL PHYSICIANS OF OHIO INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. THERESA LYNN MCFARLAND (CORPORATION SECRETARY)
(937) 233-0748
Entity
Organization
Contact information
Practice address
300 PATRICK AVENUE, URBANA, OH 43078-2339
(937) 652-1257
(937) 484-7913
Mailing address
5212 BRANDT PIKE, SUITE A, HUBER HEIGHTS, OH 45424-6138
(937) 233-0748
(937) 233-6086
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
35043565M
OH
207R00000X
Internal Medicine Physician
35058434M
OH
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
34003765M
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000011382
ANTHEM PIN-N
OH
01
—
000000011389
ANTHEM PIN
OH
01
—
000000011437
ANTHEM PIN-F
OH
01
—
368588672030
MMO PIN-N
OH
01
—
36D0350348
CLIA
OH
01
—
394601220026
MMO PIN
OH
01
—
485805933016
MMO PIN-P
OH
01
—
485805933033
MMO PIN-F
OH
01
—
9190169
PTAN
OH
Enumeration date
07/18/2007
Last updated
09/24/2009
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