Healthcare Provider Details

I. General information

NPI: 1841415049
Provider Name (Legal Business Name): SUMIT BAPNA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 03/04/2021
Certification Date: 03/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6325 EMERALD PKWY STE 1B
DUBLIN OH
43016-3241
US

IV. Provider business mailing address

6325 EMERALD PKWY STE 1B
DUBLIN OH
43016-3241
US

V. Phone/Fax

Practice location:
  • Phone: 614-876-6673
  • Fax: 614-876-8674
Mailing address:
  • Phone: 614-876-6673
  • Fax: 614-876-8674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number35088221
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number35.088221
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: