Healthcare Provider Details

I. General information

NPI: 1023002714
Provider Name (Legal Business Name): LEENA TARIGOPULA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 11/07/2023
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 OLENTANGY RIVER RD
COLUMBUS OH
43202-1523
US

IV. Provider business mailing address

3400 OLENTANGY RIVER RD
COLUMBUS OH
43202-1523
US

V. Phone/Fax

Practice location:
  • Phone: 614-754-5500
  • Fax: 614-754-5501
Mailing address:
  • Phone: 614-754-5500
  • Fax: 614-457-9519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number35083102
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: