MEDICARE: MR. DAVID R RALSTON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician	35062009	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164408472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID R RALSTON MD

Provider Business Mailing Address
First Line	:	745 WEST STATE ST
Second Line	:	STE 510
City	:	COLUMBUS
State	:	OH
Zip	:	43222-1515
Country	:	US
Telephone Number	:	614-464-0788
Fax Number	:	614-464-0295

Provider Business Practice Location Address
First Line	:	5300 N MEADOWS DR STE 3800
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-2546
Country	:	US
Telephone Number	:	614-663-3877
Fax Number	:	614-663-3878

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	08/14/2019

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