Healthcare Provider Details

I. General information

NPI: 1295842474
Provider Name (Legal Business Name): DEPT OF VETERAN AFFAIRS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

543 TAYLOR AVE
COLUMBUS OH
43203-1278
US

IV. Provider business mailing address

543 TAYLOR AVE
COLUMBUS OH
43203-1278
US

V. Phone/Fax

Practice location:
  • Phone: 614-257-5440
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QV0200X
TaxonomyVA Clinic/Center
License Number35-07-6374-Q
License Number StateOH

VIII. Authorized Official

Name: DR. AZEEM ABDUL QURESHI
Title or Position: PSYCHIATRIST
Credential: M.D.
Phone: 614-257-5440