Healthcare Provider Details

I. General information

NPI: 1376529453
Provider Name (Legal Business Name): THOMAS G HOSPEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 01/05/2022
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6955 HOSPITAL DR MAX SPORTS MEDICINE
DUBLIN OH
43016-8580
US

IV. Provider business mailing address

PO BOX 7527
DUBLIN OH
43017-0727
US

V. Phone/Fax

Practice location:
  • Phone: 614-566-1420
  • Fax: 614-566-1429
Mailing address:
  • Phone: 614-544-6356
  • Fax: 614-544-6370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number35074828
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number35-074828
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35074828
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: