Provider Demographics
NPI:1851322358
Name:OHLY, KARL A (DO)
Entity type:Individual
Prefix:
First Name:KARL
Middle Name:A
Last Name:OHLY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-0449
Mailing Address - Country:US
Mailing Address - Phone:740-374-4500
Mailing Address - Fax:740-374-5887
Practice Address - Street 1:310 E. EIGHTH ST.
Practice Address - Street 2:SUITE 130
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750
Practice Address - Country:US
Practice Address - Phone:740-373-7197
Practice Address - Fax:740-373-7198
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008795208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810005885Medicaid
OH2673727Medicaid
OH2673727Medicaid
OH7423031Medicare PIN
WV3810005885Medicaid