Healthcare Provider Details

I. General information

NPI: 1740252691
Provider Name (Legal Business Name): RICARDO L CARRAU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 02/17/2021
Certification Date: 02/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 W 10TH AVE FL 5
COLUMBUS OH
43210-1240
US

IV. Provider business mailing address

915 OLENTANGY RIVER RD SUITE 4000
COLUMBUS OH
43212-3153
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-8074
  • Fax: 614-293-3193
Mailing address:
  • Phone: 614-293-3470
  • Fax: 614-293-7292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number35096662
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: