Healthcare Provider Details

I. General information

NPI: 1487639134
Provider Name (Legal Business Name): DR. MATTHEW ANTHONY BRIDGER
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 E TOWN ST
COLUMBUS OH
43215-4683
US

IV. Provider business mailing address

1512 TEEWAY DR
COLUMBUS OH
43220-3953
US

V. Phone/Fax

Practice location:
  • Phone: 614-566-9191
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number356719
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: