Healthcare Provider Details

I. General information

NPI: 1851135594
Provider Name (Legal Business Name): STEPHEN NOGAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2024
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7706 OLENTANGY RIVER RD
COLUMBUS OH
43235-1317
US

IV. Provider business mailing address

PO BOX 382
GRANVILLE OH
43023-0382
US

V. Phone/Fax

Practice location:
  • Phone: 614-436-8888
  • Fax:
Mailing address:
  • Phone: 614-436-8888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KAYLEE REAU
Title or Position: OFFICE MANAGER
Credential:
Phone: 614-436-8888