Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Providence Medical Group

Organization Registered Dietitian · NPI 1972533149

Providence Medical Group is a Registered Dietitian in Dayton, Ohio. Licensed in Ohio. Registered with an NPI since 2006.

Licensed in
OH
In the registry since
2006
Specialties on file
15

Practice location Address checks out

2912 Springboro Rd W Ste 201
Dayton, OH 45439-1674
Phone: (937) 297-8999
Fax: (937) 297-4852
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X
Registered Dietitian Taxonomy 133V00000X (OH)
Diabetes Educator Registered Nurse Taxonomy 163WD0400X (OH)
Obstetrics & Gynecology Physician Taxonomy 207V00000X
Pediatrics Physician Taxonomy 208000000X
Surgery Physician Taxonomy 208600000X
Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician Taxonomy 2088F0040X
Colon & Rectal Surgery Physician Taxonomy 208C00000X
General Practice Physician Taxonomy 208D00000X
Clinical Medical Laboratory Taxonomy 291U00000X
Medical Physician Assistant Taxonomy 363AM0700X
Nurse Practitioner Taxonomy 363L00000X · Licence 1313008 (OH)
Acute Care Nurse Practitioner Taxonomy 363LA2100X
Adult Health Nurse Practitioner Taxonomy 363LA2200X
Pediatric Nurse Practitioner Taxonomy 363LP0200X

Record details

NPI number1972533149
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Susan Becker — Chief Operating Officer · (937) 297-8999
NPI enumeratedJuly 4, 2006
Last updated in NPPESOctober 19, 2022
Certification dateOctober 19, 2022
Mailing address2912 Springboro Rd W, Suite 201, Dayton, OH 45439-1674

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