Provider Demographics
NPI:1831397470
Name:DIABETES AND ENDOCRINOLOGY CENTER OF OHIO LLC
Entity type:Organization
Organization Name:DIABETES AND ENDOCRINOLOGY CENTER OF OHIO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:PELLERITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-764-0707
Mailing Address - Street 1:7281 SAWMILL RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-9021
Mailing Address - Country:US
Mailing Address - Phone:614-764-0707
Mailing Address - Fax:
Practice Address - Street 1:7281 SAWMILL RD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-9021
Practice Address - Country:US
Practice Address - Phone:614-764-0707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-085891207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP92567Medicare UPIN
OHI04349Medicare UPIN
OHH99788Medicare UPIN