Healthcare Provider Details

I. General information

NPI: 1255990891
Provider Name (Legal Business Name): KATHRYN ANDERSON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2019
Last Update Date: 12/15/2022
Certification Date: 12/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 E MAIN ST
COLUMBUS OH
43213-2440
US

IV. Provider business mailing address

5000 E MAIN ST
COLUMBUS OH
43213-2440
US

V. Phone/Fax

Practice location:
  • Phone: 614-235-5555
  • Fax:
Mailing address:
  • Phone: 614-235-5555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34.015959
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: