Healthcare Provider Details

I. General information

NPI: 1356917686
Provider Name (Legal Business Name): BECKY GLORIA MIRSKY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2021
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 W 10TH AVE
COLUMBUS OH
43210-1240
US

IV. Provider business mailing address

1474 PRESIDENTIAL DR
COLUMBUS OH
43212-1217
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-8000
  • Fax:
Mailing address:
  • Phone: 859-684-5612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberTP273
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number38179
License Number StateOK
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number57.253658
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: