Healthcare Provider Details

I. General information

NPI: 1881980605
Provider Name (Legal Business Name): ERIC C. STORTS D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2011
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 N MAIN ST
LONDON OH
43140-1115
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 740-845-7700
  • Fax: 740-845-7701
Mailing address:
  • Phone: 740-845-7700
  • Fax: 740-845-7701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number000933
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number000933
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number000933
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36.003794
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: