Healthcare Provider Details

I. General information

NPI: 1942946314
Provider Name (Legal Business Name): JOSHUA EDWARD MORMOL DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2022
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 TAMARACK RD
NEWARK OH
43055-2303
US

IV. Provider business mailing address

6847 STEWART RD APT 239
CINCINNATI OH
45236-4242
US

V. Phone/Fax

Practice location:
  • Phone: 614-339-2000
  • Fax:
Mailing address:
  • Phone: 614-579-6398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberAPP-000568409
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: