Healthcare Provider Details

I. General information

NPI: 1184864431
Provider Name (Legal Business Name): LINDSAY RERKO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2009
Last Update Date: 10/17/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 ALTAIR PKWY STE 3100
WESTERVILLE OH
43082-7653
US

IV. Provider business mailing address

400 ALTAIR PKWY STE 3100
WESTERVILLE OH
43082-7653
US

V. Phone/Fax

Practice location:
  • Phone: 614-360-9995
  • Fax: 614-745-0165
Mailing address:
  • Phone: 614-360-9995
  • Fax: 614-745-0165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34-009871
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS-016056
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: