Healthcare Provider Details

I. General information

NPI: 1831314236
Provider Name (Legal Business Name): KRISTEN SPELLACY LEWIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTEN M. SPELLACY

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 W 10TH AVE FL 2
COLUMBUS OH
43210-1240
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-7499
  • Fax: 614-366-2360
Mailing address:
  • Phone: 614-293-7499
  • Fax: 614-366-2360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.089093
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.089093
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number35.089093
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: