Healthcare Provider Details

I. General information

NPI: 1639169600
Provider Name (Legal Business Name): CURTIS L GINGRICH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 05/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4850 E MAIN ST
COLUMBUS OH
43213-3162
US

IV. Provider business mailing address

5350 FRANTZ RD
DUBLIN OH
43016-4259
US

V. Phone/Fax

Practice location:
  • Phone: 614-566-0950
  • Fax: 614-566-0766
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35065523
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: