Mark Davanzo MD LLC

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

Legal business name

MARK DAVANZO MD LLC

Practice address

477 Cooper Road
Suite 440
Westerville, OH 43081-8053

Phone

(614) 898-5520

Fax

(614) 898-5563

NPI assigned

Dec 22, 2008

Last updated

Feb 18, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mark E. Davanzo, MD

Title

MD/Owner Authorized Official

Phone

(614) 898-5561

Specialties & licenses 2

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1229904000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1297987200000",
    "number": "1548406556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "477 COOPER ROAD",
            "address_2": "SUITE 440",
            "city": "WESTERVILLE",
            "state": "OH",
            "postal_code": "430818053",
            "telephone_number": "614-898-5520",
            "fax_number": "614-898-5563"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "477 COOPER ROAD",
            "address_2": "SUITE 440",
            "city": "WESTERVILLE",
            "state": "OH",
            "postal_code": "430818053",
            "telephone_number": "614-898-5520",
            "fax_number": "614-898-5563"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK DAVANZO MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-22",
        "last_updated": "2011-02-18",
        "status": "A",
        "authorized_official_last_name": "DAVANZO",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "MD/OWNER AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "614-898-5561",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "OH",
            "license": "35042997",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "OH",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "DP3368",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.