DR. ROBERT EDWIN EXTEN JR. (NPI# 1205832375) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1205832375 |
Entity Type | Individual |
Full Name | DR. ROBERT EDWIN EXTEN JR. |
Credential | MD |
Practice Address |
475 Lexington Ave Mansfield OH 44907-1501 |
Practice Telephone | 4197562003 |
Practice Fax Number | 4197563637 |
Mailing Telephone | 4197562003 |
Mailing Fax Number | 4197563637 |
Enumeration Date | 2005-06-23 |
Last Update Date | 2010-01-26 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 207RH0003X |
Internal Medicine Specialization: Hematology & Oncology |
35038459E | OH | Allopathic & Osteopathic Physicians |
State | Issuer | Identifier | Type Code |
---|---|---|---|
OH | 0519460 | 05 | |
OH | MEDICARE RAILRROAD | 830006430 | 01 |
OH | ANTHEM | 000000142119 | 01 |
Street Address |
475 LEXINGTON AVE |
City | MANSFIELD |
State | OH |
Zip Code | 44907-1501 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1528687589 | Lorrie L. Hedrick | Counselor | 475 Lexington Ave, Mansfield, OH 44907-1501 | 2020-04-10 |
1164041125 | Alissa R Keysor | Licensed Practical Nurse | 475 Lexington Ave, Mansfield, OH 44907-1501 | 2020-04-10 |
1013579234 | Shaunqua S Crawford | Licensed Practical Nurse | 475 Lexington Ave, Mansfield, OH 44907-1501 | 2019-07-09 |
1184053100 | Tammy Canfield | Nurse Practitioner | 475 Lexington Ave, Mansfield, OH 44907-1501 | 2013-11-12 |
1821148404 | Woodside Medical Group, Inc. | Clinic/Center | 475 Lexington Ave, Mansfield, OH 44907-1501 | 2007-01-12 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1053932434 | Kerri Nichole Tolliver | Licensed Practical Nurse | Mansfield Comprehensive Treatment Center, 475 Lexington Ave, Mansfield, OH 44907 | 2020-04-27 |
1790325371 | Gabrielle Smith | Licensed Practical Nurse | 707 Scholl Rd, Mansfield, OH 44907 | 2020-01-10 |
1912544982 | Heidi L Mathews | Behavior Technician | 270 Sterkel Blvd., Mansfield, OH 44907 | 2019-12-09 |
1851942254 | Misty J Kline | Licensed Practical Nurse | 707 Scholl Rd., Mansfield, OH 44907 | 2019-09-26 |
1528533320 | Ohio Treatment Center, LLC | Clinic/Center | 475 Lexington Ave., Mansfield, OH 44907 | 2018-10-08 |
1750898722 | Hannah Rose Hardin | Behavior Technician | 1033 Larchwood R, Mansfield, OH 44907 | 2017-12-29 |
1932548856 | Jessica Alexis Taylor | Counselor | 641 Scholl Rd., Mansfield, OH 44907 | 2013-06-25 |
1336495258 | Sonal Sinha | Psychiatry & Neurology | 341 Cline Ave Ste 1, Mansfield, OH 44907 | 2012-07-29 |
1427321579 | Tara Kightlinger | Community Health Worker | 442 Brenda Dr, Mansfield, OH 44907 | 2012-02-21 |
1649557620 | William Scott Olar | Chiropractor | 1179 Lexington Ave, Mansfield, OH 44907 | 2011-11-04 |
Find all providers in zip 44907 |
Taxonomy Code | 207RH0003X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Internal Medicine |
Specialization | Hematology & Oncology |
An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered. |
Notes: Source: American Osteopathic Board of Internal Medicine, 2007. [7/1/2008: definiton added, source added; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1538147525 | Donald Lee Dewald | Internal Medicine | 1125 Aspira Ct, Mansfield, OH 44906-4125 | 2006-01-09 |
1952694739 | Paula A. Mcbrine, M.d., P.C. | Internal Medicine | 205 Chauncy St, Mansfield, MA 02048-1202 | 2011-05-26 |
1700040490 | Dallas Oncology Consultants Pa | Internal Medicine | 2800 E Broad St, Suite 212, Mansfield, TX 76063-6409 | 2008-07-11 |
1689644114 | Shahzad M Khan | Internal Medicine | 1125 Aspira Ct, Mansfield, OH 44906-4125 | 2006-01-26 |
1972573848 | Saurabh Das | Internal Medicine | 1125 Aspira Ct, Mansfield, OH 44906-4125 | 2006-01-24 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1013315076 | Clermont County Cancer Center LLC | Internal Medicine | 4402 Hartman Ln, Batavia, OH 45103-1971 | 2014-12-08 |
1215353834 | Ahmed M Ghany | Internal Medicine | 100 W 3rd Ave Ste 150, Columbus, OH 43201-3260 | 2014-03-06 |
1972935716 | Stanley P Balcerzak | Internal Medicine | 3113 N 3 Bs and K Rd, Sunbury, OH 43074-9674 | 2013-08-03 |
1184056996 | Mohammad Ansari-dezfuli | Internal Medicine | 1700 Carriage Place, Gates Mills, OH 44040 | 2013-08-02 |
1043569486 | Virginia Ann Rhodes | Internal Medicine | 1557 Landsdale Cir, Twinsburg, OH 44087-3337 | 2012-08-30 |
1629324009 | Earl Nelson Metz | Internal Medicine | 226 E. Dublin Granville Rd., Worthington, OH 43085-3185 | 2012-08-03 |
1366715260 | John Kiess Kurtz | Internal Medicine | 3676 Kehrer Rd, Bucyrus, OH 44820-8624 | 2012-02-23 |
1922398049 | Vamsi Koduri | Internal Medicine | 4435 State Route 159, Chillicothe, OH 45601 | 2011-04-11 |
1528392297 | William H Sigalove | Internal Medicine | 130 Meadow Dr, Elyria, OH 44035-1838 | 2009-09-28 |
1922236017 | Amir Iqbal | Internal Medicine | 885 S Sawburg Ave, Suite 110, Alliance, OH 44601-5926 | 2009-06-26 |
Find all providers with the same taxonomy |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.