Provider Demographics
NPI:1144650953
Name:DENISON MEDICAL GROUP LLC
Entity type:Organization
Organization Name:DENISON MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELIO
Authorized Official - Middle Name:
Authorized Official - Last Name:VENTRESCA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-907-3065
Mailing Address - Street 1:30 PICKETT PL
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-8415
Mailing Address - Country:US
Mailing Address - Phone:614-907-3065
Mailing Address - Fax:
Practice Address - Street 1:3805 EMERALD PKWY
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-3317
Practice Address - Country:US
Practice Address - Phone:614-907-3065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-14
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-058803208M00000X
OH208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0097387Medicaid
OH0097387Medicaid