Healthcare Provider Details

I. General information

NPI: 1407048085
Provider Name (Legal Business Name): ANTHONY JOSEPH EWALD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2007
Last Update Date: 12/22/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 POLARIS PKWY STE 3400
WESTERVILLE OH
43082-7989
US

IV. Provider business mailing address

5350 FRANTZ RD
DUBLIN OH
43016-4259
US

V. Phone/Fax

Practice location:
  • Phone: 614-588-0020
  • Fax: 614-588-0031
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number35092666
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: