Healthcare Provider Details

I. General information

NPI: 1386367084
Provider Name (Legal Business Name): MATTHEW COLONNA PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 N HAMILTON RD STE 255
GAHANNA OH
43230-8703
US

IV. Provider business mailing address

PO BOX 7527
DUBLIN OH
43017-0727
US

V. Phone/Fax

Practice location:
  • Phone: 614-788-9199
  • Fax: 614-533-0232
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.008261RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: