Healthcare Provider Details

I. General information

NPI: 1477550903
Provider Name (Legal Business Name): TODD LOREN ASTOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 07/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 S 18TH ST
COLUMBUS OH
43205-2654
US

IV. Provider business mailing address

555 S 18TH ST
COLUMBUS OH
43205-2654
US

V. Phone/Fax

Practice location:
  • Phone: 614-722-3489
  • Fax: 614-722-3426
Mailing address:
  • Phone: 614-722-3489
  • Fax: 614-722-3426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35084759
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number35084759
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number35084759
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: