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General NPI Number Information
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NPI Number | 1598816514
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Entity Type | Organization
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Legal Business Name | COLUMBUS EAST INTERNAL MEDICINE
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 05/07/2008
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Provider Practice Location Address
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Address Line | 1075 BEECHER XING N STE A
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City | GAHANNA
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State | OH
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Zip | 43230-4572
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Country | US
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Telephone | 614-475-6712
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Fax | 614-475-6902
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Provider Business Mailing Address
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Address Line | 1075-A BEECHER CROSSING NORTH
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City | GAHANNA
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State | OH
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Zip | 43230-8703
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Country | US
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Telephone | 614-475-6712
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Fax | 614-475-6902
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Authorized Official
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Title or Position | PARTNER
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Name | DR. LISA J BRAVERMAN
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Credential | M.D.
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Telephone | 614-475-6712
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 35062326
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License Number State | OH
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