Healthcare Provider Details

I. General information

NPI: 1699871657
Provider Name (Legal Business Name): ELIZABETH CAPOCASALE HURST MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 01/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 REED RD
COLUMBUS OH
43220
US

IV. Provider business mailing address

7085 BLUFFPOINT CT
COLUMBUS OH
43235
US

V. Phone/Fax

Practice location:
  • Phone: 614-538-8300
  • Fax: 614-538-1656
Mailing address:
  • Phone: 614-538-8300
  • Fax: 614-538-1656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberOH-35-05-3969-H
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: