Healthcare Provider Details

I. General information

NPI: 1841252244
Provider Name (Legal Business Name): L. ROBERT POLSTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6495 E BROAD ST SUITE A
COLUMBUS OH
43213-1541
US

IV. Provider business mailing address

6495 E BROAD ST SUITE A
COLUMBUS OH
43213-1541
US

V. Phone/Fax

Practice location:
  • Phone: 614-866-8077
  • Fax: 614-866-9752
Mailing address:
  • Phone: 614-866-8077
  • Fax: 614-866-9752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number35031032
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: