Basic Information
| Provider Information | |||||||||
| NPI: | 1528263266 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALLERGY & ASTHMA ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2359 LAKEVIEW DRIVE | ||||||||
| Address2: | |||||||||
| City: | BEAVER CREEK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454313695 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374310721 | ||||||||
| FaxNumber: | 9374315419 | ||||||||
| Practice Location | |||||||||
| Address1: | 5692 FAR HILLS AVENUE | ||||||||
| Address2: | LOWER LEVEL #6 | ||||||||
| City: | KETTERING | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454292271 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9344344611 | ||||||||
| FaxNumber: | 9374349107 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | PARKER | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER PRESIDENT PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 9374310721 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207K00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Allergy & Immunology |
ID Information
| ID | Type | State | Issuer | Description | 2555444 | 05 | OH | MEDICAID |