Healthcare Provider Details

I. General information

NPI: 1609842962
Provider Name (Legal Business Name): OLENTANGY PEDIATRICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 07/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4775 KNIGHTSBRIDGE BLVD SUITE 207
COLUMBUS OH
43214-4313
US

IV. Provider business mailing address

4775 KNIGHTSBRIDGE BLVD SUITE 207
COLUMBUS OH
43214-4313
US

V. Phone/Fax

Practice location:
  • Phone: 614-442-5557
  • Fax: 614-442-1070
Mailing address:
  • Phone: 614-442-5557
  • Fax: 614-442-1070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: SHERRY V ROBISON
Title or Position: OFFICE MANAGER
Credential:
Phone: 614-442-9004