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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