Healthcare Provider Details

I. General information

NPI: 1477547719
Provider Name (Legal Business Name): RICHARD A EDGIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 12/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 MCNAUGHTEN RD SUITE 320
COLUMBUS OH
43213-2174
US

IV. Provider business mailing address

1236 KENBROOK HILLS DR
COLUMBUS OH
43220-4968
US

V. Phone/Fax

Practice location:
  • Phone: 614-754-5500
  • Fax: 614-754-5501
Mailing address:
  • Phone: 614-745-4511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number35062899
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: