Healthcare Provider Details

I. General information

NPI: 1376639302
Provider Name (Legal Business Name): STEPHEN ANDREW KOFF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 01/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 S 18TH ST SUITE 6D
COLUMBUS OH
43205-2654
US

IV. Provider business mailing address

700 CHILDREN'S DRIVE ED. BLDG. 3RD FLOOR
COLUMBUS OH
43205-2664
US

V. Phone/Fax

Practice location:
  • Phone: 614-722-3114
  • Fax: 614-722-3122
Mailing address:
  • Phone: 614-722-4823
  • Fax: 614-722-4823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number36-047763
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: