Healthcare Provider Details

I. General information

NPI: 1386836922
Provider Name (Legal Business Name): ESTEBAN FERNANDEZ FAITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2007
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 S 18TH ST
COLUMBUS OH
43205-2654
US

IV. Provider business mailing address

700 CHILDRENS DR
COLUMBUS OH
43205-2664
US

V. Phone/Fax

Practice location:
  • Phone: 614-722-6200
  • Fax:
Mailing address:
  • Phone: 614-722-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number35-097444
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number35-097444
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: