Healthcare Provider Details

I. General information

NPI: 1881226744
Provider Name (Legal Business Name): ADRIAN GORZITZE-MAXEY PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2020
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6905 HOSPITAL DR STE 130
DUBLIN OH
43016-9600
US

IV. Provider business mailing address

117 W COMO AVE
COLUMBUS OH
43202-1027
US

V. Phone/Fax

Practice location:
  • Phone: 614-923-0300
  • Fax:
Mailing address:
  • Phone: 614-937-9896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.006367RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: