Healthcare Provider Details

I. General information

NPI: 1134153778
Provider Name (Legal Business Name): CHRISTOPHER E PELLOSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 02/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W 10TH AVE
COLUMBUS OH
43210-1280
US

IV. Provider business mailing address

300 W 10TH AVE
COLUMBUS OH
43210-1280
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-8415
  • Fax: 614-293-4044
Mailing address:
  • Phone: 614-293-8415
  • Fax: 614-293-4044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number35.094829
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: