Healthcare Provider Details

I. General information

NPI: 1003809088
Provider Name (Legal Business Name): ANDREW CARRINGTON GOMBASH D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ANDREW C. GOMBASH D.O.

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 01/23/2023
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 E RIVERVIEW AVE
NAPOLEON OH
43545-9805
US

IV. Provider business mailing address

1600 E RIVERVIEW AVE
NAPOLEON OH
43545-9805
US

V. Phone/Fax

Practice location:
  • Phone: 194-592-1071
  • Fax: 194-592-1076
Mailing address:
  • Phone: 419-592-1071
  • Fax: 419-592-1076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34004365G
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: