Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 35128597 | OH |
N | 207RA0201X | Internist - Allergy & Immunology | 35128597 | OH |
Y | 2080P0201X | Pediatric Allergist | 35128597 | OH |
NPI | 1720005267 |
---|---|
Provider Name | Dr. Mitchell H Grayson |
First Address | Columbus, OH 43205-2664 |
Second Address | Columbus, OH 43205-2664 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 16/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G49745 | (02) |