Healthcare Provider Details

I. General information

NPI: 1134190242
Provider Name (Legal Business Name): DANIEL W PIETRYGA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 08/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MCCONNELL RD
COLUMBUS OH
43214-3463
US

IV. Provider business mailing address

5400 FRANTZ RD SUITE 250
DUBLIN OH
43016-4144
US

V. Phone/Fax

Practice location:
  • Phone: 614-566-5377
  • Fax:
Mailing address:
  • Phone: 614-544-6161
  • Fax: 614-544-6370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35054527
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number35054527
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: