Healthcare Provider Details

I. General information

NPI: 1477534204
Provider Name (Legal Business Name): SANJAY R GARUDA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 12/15/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3820 OLENTANGY RIVER RD
COLUMBUS OH
43214-5403
US

IV. Provider business mailing address

3820 OLENTANGY RIVER RD OHIO GASTROENTEROLOGY GROUP INC
COLUMBUS OH
43214-5403
US

V. Phone/Fax

Practice location:
  • Phone: 614-457-1213
  • Fax: 614-457-9517
Mailing address:
  • Phone: 614-457-1213
  • Fax: 614-457-9519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number35087037
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: