Provider Demographics
NPI:1366406696
Name:ARNOLD, MISTY E (MD)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:E
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 HEMPSTEAD STATION DR
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-5164
Mailing Address - Country:US
Mailing Address - Phone:800-875-0136
Mailing Address - Fax:937-619-4231
Practice Address - Street 1:561 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-1410
Practice Address - Country:US
Practice Address - Phone:740-369-8711
Practice Address - Fax:740-368-5050
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35069284207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000317005OtherIND BC/BS PROVIDER # GRDY
OH203413OtherGRP EEOICP # AT GRADY
OHP00073867OtherIND RRMEDICARE # AT GRDY
OH2006224Medicaid
OH2006224Medicaid
OH000000317005OtherIND BC/BS PROVIDER # GRDY
OHG51575Medicare UPIN