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
1820 C STREET, LIMA, OH 45804-1832
(419) 222-4559
(419) 222-4589
Mailing address
5212 BRANDT PIKE, SUITE A, HUBER HEIGHTS, OH 45424-6138
(937) 233-0748
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
35 04 3565M
OH
207R00000X
Internal Medicine Physician
35 05 8434M
OH
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
34003765F
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000011383
ANTHEM PIN
OH
01
—
000000011437
ANTHEM PIN
OH
01
—
000000066851
ANTHEM PIN
OH
01
—
368588672019
MMO PIN
OH
01
—
394601220019
MMO PIN
OH
01
—
485805933016
MMO PIN
OH
01
—
485805933022
MMO PIN
OH
01
—
9190167
PTAN
OH
Enumeration date
06/06/2007
Last updated
10/05/2009
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