=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326000472
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SCOTT BAGENSTOSE MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/04/2006
-----------------------------------------------------
Last Update Date | 02/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5610 N HAMILTON RD
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43230-1324
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-933-0312
-----------------------------------------------------
Fax | 614-933-8903
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1810 MACKENZIE DR FL 2
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43220-2967
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-273-2250
-----------------------------------------------------
Fax | 614-273-2255
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207K00000X
-----------------------------------------------------
Taxonomy Name | Allergy & Immunology Physician
-----------------------------------------------------
License Number | 35081229B
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------