Healthcare Provider Details

I. General information

NPI: 1174121214
Provider Name (Legal Business Name): ANDREW CLARK OSWALT MDIV
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2020
Last Update Date: 10/12/2020
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 OAKLAND PARK AVE
COLUMBUS OH
43214-4119
US

IV. Provider business mailing address

45 OAKLAND PARK AVE
COLUMBUS OH
43214-4119
US

V. Phone/Fax

Practice location:
  • Phone: 614-668-2332
  • Fax:
Mailing address:
  • Phone: 614-668-2332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: