Healthcare Provider Details

I. General information

NPI: 1013158591
Provider Name (Legal Business Name): CROSSWOODS PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2009
Last Update Date: 03/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 LAKEVIEW PLAZA BLVD SUITE 500
WORTHINGTON OH
43085-4734
US

IV. Provider business mailing address

760 LAKEVIEW PLAZA BLVD SUITE 500
WORTHINGTON OH
43085
US

V. Phone/Fax

Practice location:
  • Phone: 614-540-7339
  • Fax: 614-540-7338
Mailing address:
  • Phone: 614-540-7339
  • Fax: 614-540-7338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number35058655
License Number StateOH

VIII. Authorized Official

Name: DR. JOSEPH FIALA
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 614-540-7339