Healthcare Provider Details

I. General information

NPI: 1629047121
Provider Name (Legal Business Name): RUTH R MULLOWNEY-AGRA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 02/22/2022
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2970 W BROAD ST
COLUMBUS OH
43204-2649
US

IV. Provider business mailing address

775 W BROAD ST STE 200
COLUMBUS OH
43222-1471
US

V. Phone/Fax

Practice location:
  • Phone: 614-279-0808
  • Fax: 614-279-6111
Mailing address:
  • Phone: 614-627-1610
  • Fax: 614-228-5040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number35077611
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: