Healthcare Provider Details

I. General information

NPI: 1790732188
Provider Name (Legal Business Name): TODD DAVID TROY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 ROCKY FORK BLVD
GAHANNA OH
43230-3336
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 614-383-7660
  • Fax: 614-383-7665
Mailing address:
  • Phone: 614-383-7660
  • Fax: 614-383-7665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50.003518RX
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number50.003518
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.003518RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: