Healthcare Provider Details

I. General information

NPI: 1952444994
Provider Name (Legal Business Name): WAEL N. JARJOUR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 06/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 MEDICAL DRIVE
COLUMBUS OH
43210-1240
US

IV. Provider business mailing address

700 ACKERMAN RD SUITE 385
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-4837
  • Fax: 614-293-5631
Mailing address:
  • Phone: 614-947-3700
  • Fax: 614-947-3771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number0101058621
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number35093596
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: