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General NPI Number Information
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NPI Number | 1043373459
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Entity Type | Organization
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Legal Business Name | NORTHEAST ORTHOPEDICS INC
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 06/05/2008
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Provider Practice Location Address
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Address Line | 164 WETHERBY LN
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City | WESTERVILLE
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State | OH
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Zip | 43081-4957
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Country | US
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Telephone | 614-839-2300
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Fax | 614-839-2301
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Provider Business Mailing Address
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Address Line | 164 WETHERBY LN
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City | WESTERVILLE
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State | OH
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Zip | 43081-4957
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Country | US
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Telephone | 614-839-2300
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Fax | 614-839-2301
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MERLE KENNEDY
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Credential | MD
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Telephone | 614-839-2300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | OH
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