Healthcare Provider Details

I. General information

NPI: 1235134172
Provider Name (Legal Business Name): LAURA E OSTHAUS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 10/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 CLAIREDAN DR.
POWELL OH
43065
US

IV. Provider business mailing address

55 CLAIREDAN DR.
POWELL OH
43065
US

V. Phone/Fax

Practice location:
  • Phone: 614-888-8989
  • Fax: 614-888-8968
Mailing address:
  • Phone: 614-888-8989
  • Fax: 614-888-8968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35-08-1483-0
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: