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General NPI Number Information
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NPI Number | 1861925430
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Entity Type | Organization
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Legal Business Name | OHIO DIGESTIVE AND LIVER ASSOCIATES LLC
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Dates
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Enumeration Date | 04/10/2017
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Last Update Date | 04/10/2017
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Provider Practice Location Address
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Address Line | 503 WOOSTER RD
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City | MOUNT VERNON
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State | OH
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Zip | 43050-1486
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Country | US
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Telephone | 917-432-7333
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Fax | 609-798-0789
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Provider Business Mailing Address
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Address Line | 4619 SANDWICH CT
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City | DUBLIN
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State | OH
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Zip | 43016-8292
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Country | US
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Telephone | 917-432-7333
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Fax | 609-798-0789
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Authorized Official
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Title or Position | OWNER
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Name | DR. GHULAM MUJTABA
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Credential | M.D
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Telephone | 917-432-7333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 35097038
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License Number State | OH
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