Organization Name: | MARK DAVANZO MD LLC |
NPI Number: | 1548406556 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MARK E. DAVANZO (MD/OWNER AUTHORIZED OFFICIAL) |
Mailing Address: | 477 Cooper Road Suite 440 Westerville |
State: | OH US |
Postal Code: | 430818053 |
Phone Number: | 6148985520 |
Fax Number: | 6148985563 |
NPI Enumeration Date: | 12/22/2008 |
NPI Last Update Date: | 02/18/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 35042997 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | OH |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |