Healthcare Provider Details

I. General information

NPI: 1467059808
Provider Name (Legal Business Name): CONNOR BRADLY PRUSZ PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2020
Last Update Date: 03/20/2025
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6670 PERIMETER DRIVE STE 140
DUBLIN OH
43016-8057
US

IV. Provider business mailing address

6670 PERIMETER DRIVE STE 140
DUBLIN OH
43016-8057
US

V. Phone/Fax

Practice location:
  • Phone: 614-526-2150
  • Fax: 614-526-2151
Mailing address:
  • Phone: 614-526-2150
  • Fax: 614-526-2151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPENDING
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.006854RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: