Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 35073448 | OH |
NPI | 1003860008 |
---|---|
Provider Name | Dana S Vallangeon |
First Address | Columbus, OH 43222-1337 |
Second Address | Columbus, OH 43222-1317 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2006 |
Last Update Date | 07/08/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
080177215 | RAILROAD MEDICARE (01) | OH |
2121304 | (05) | OH |
H02353 | (02) | OH |