Healthcare Provider Details

I. General information

NPI: 1295846673
Provider Name (Legal Business Name): JAMES GLENN FITKIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 06/04/2022
Certification Date: 06/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1733 ARDLEIGH RD
COLUMBUS OH
43221-1401
US

IV. Provider business mailing address

1733 ARDLEIGH RD
COLUMBUS OH
43221-1401
US

V. Phone/Fax

Practice location:
  • Phone: 614-949-4957
  • Fax:
Mailing address:
  • Phone: 614-949-4957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number35072294
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: