Healthcare Provider Details

I. General information

NPI: 1750306452
Provider Name (Legal Business Name): ANN ZORETIC ANSEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 02/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4030 HENDERSON RD
COLUMBUS OH
43220-2287
US

IV. Provider business mailing address

4030 HENDERSON RD
COLUMBUS OH
43220-2287
US

V. Phone/Fax

Practice location:
  • Phone: 614-442-7550
  • Fax: 614-442-4100
Mailing address:
  • Phone: 614-442-7550
  • Fax: 614-442-4100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number35-059410
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: