MEDICARE: DR. JONATHAN STEWART PEDRICK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	208100000X	Physical Medicine & Rehabilitation Physician	35.097460	OH

General Provider Information

NPI Number	:	1235375957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN STEWART PEDRICK M.D.

Provider Business Mailing Address
First Line	:	PO BOX 7527
Second Line	:
City	:	DUBLIN
State	:	OH
Zip	:	43017-0727
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5150 E DUBLIN GRANVILLE RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43081-8701
Country	:	US
Telephone Number	:	614-533-5500
Fax Number	:	614-533-0103

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/30/2008
Last Update Date	:	09/21/2023

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