Provider Demographics
NPI:1538147988
Name:WHITFIELD, DAMON M (DO)
Entity type:Individual
Prefix:
First Name:DAMON
Middle Name:M
Last Name:WHITFIELD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7811 LINDELL LN
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-9657
Mailing Address - Country:US
Mailing Address - Phone:614-804-2274
Mailing Address - Fax:
Practice Address - Street 1:10208 SAWMILL PKWY
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-9189
Practice Address - Country:US
Practice Address - Phone:614-792-2779
Practice Address - Fax:614-792-7255
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-05
Last Update Date:2017-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007350208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH08443Medicare UPIN
OH4022879Medicare PIN