Healthcare Provider Details

I. General information

NPI: 1629148242
Provider Name (Legal Business Name): CENTRAL OHIO NEWBORN MEDICINE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 E STATE ST STE 520
COLUMBUS OH
43215-4359
US

IV. Provider business mailing address

285 E STATE ST STE 520
COLUMBUS OH
43215-4359
US

V. Phone/Fax

Practice location:
  • Phone: 614-566-9683
  • Fax: 614-566-8046
Mailing address:
  • Phone: 614-566-9683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CRAIG W ANDERSON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 614-566-9683