Healthcare Provider Details

I. General information

NPI: 1548239866
Provider Name (Legal Business Name): THEODORE JOSEPH PARKER P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 03/21/2022
Certification Date: 03/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 MCNAUGHTEN RD
COLUMBUS OH
43213-2174
US

IV. Provider business mailing address

85 MCNAUGHTEN RD
COLUMBUS OH
43213-2174
US

V. Phone/Fax

Practice location:
  • Phone: 614-627-2000
  • Fax:
Mailing address:
  • Phone: 614-627-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50001764
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: