Healthcare Provider Details

I. General information

NPI: 1417290982
Provider Name (Legal Business Name): VIRGIL SECASANU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2013
Last Update Date: 02/25/2022
Certification Date: 02/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 E BROAD ST
COLUMBUS OH
43213-1502
US

IV. Provider business mailing address

150 TAYLOR STATION RD STE 200
COLUMBUS OH
43213-4470
US

V. Phone/Fax

Practice location:
  • Phone: 614-234-6000
  • Fax:
Mailing address:
  • Phone: 614-627-1300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number35.128503
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number35.128503
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: