Healthcare Provider Details

I. General information

NPI: 1669478459
Provider Name (Legal Business Name): SAMUEL WASHINGTON DUDLEY III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2005
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CHILDREN'S DRIVE
COLUMBUS OH
43205-2664
US

IV. Provider business mailing address

700 CHILDREN'S DRIVE
COLUMBUS OH
43205-2664
US

V. Phone/Fax

Practice location:
  • Phone: 614-722-4554
  • Fax: 614-722-4565
Mailing address:
  • Phone: 614-722-2000
  • Fax: 614-355-4497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0008X
TaxonomyPediatric Neurodevelopmental Disabilities Physician
License Number35079310
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number35079310
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35079310
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: