Healthcare Provider Details

I. General information

NPI: 1255334090
Provider Name (Legal Business Name): RICHARD NADALIN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 12/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

453 WATERBURY CT STE 200
GAHANNA OH
43230-5309
US

IV. Provider business mailing address

PO BOX 30977
GAHANNA OH
43230-0977
US

V. Phone/Fax

Practice location:
  • Phone: 614-428-7701
  • Fax:
Mailing address:
  • Phone: 614-428-7701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36001683
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: