Healthcare Provider Details

I. General information

NPI: 1861486961
Provider Name (Legal Business Name): ANGELA M WEATHERWAX PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 OLENTANGY RIVER RD SUITE 2050
COLUMBUS OH
43214-3912
US

IV. Provider business mailing address

5350 FRANTZ RD
DUBLIN OH
43016-4259
US

V. Phone/Fax

Practice location:
  • Phone: 614-566-2450
  • Fax: 614-566-1895
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50-002174
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: