Healthcare Provider Details

I. General information

NPI: 1447362967
Provider Name (Legal Business Name): ROBERT J SKULLY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 01/25/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

393 E TOWN ST STE 116
COLUMBUS OH
43215-4799
US

IV. Provider business mailing address

1299 OLENTANGY RIVER RD STE 103
COLUMBUS OH
43212-3118
US

V. Phone/Fax

Practice location:
  • Phone: 614-566-9108
  • Fax:
Mailing address:
  • Phone: 614-566-4278
  • Fax: 614-566-5424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35046672
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: