Provider Demographics
NPI:1245286715
Name:DAYTON COLON RECTAL CENTER, INC.
Entity type:Organization
Organization Name:DAYTON COLON RECTAL CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEEPAK
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-435-8663
Mailing Address - Street 1:5932 SPRINGBORO PIKE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45449-3250
Mailing Address - Country:US
Mailing Address - Phone:937-435-8663
Mailing Address - Fax:937-435-8966
Practice Address - Street 1:5932 SPRINGBORO PIKE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45449-3250
Practice Address - Country:US
Practice Address - Phone:937-435-8663
Practice Address - Fax:937-435-8966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9309351Medicare ID - Type Unspecified