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1699736165

NPI Code Detail

MEDICARE: JORGE ALBERTO VIDAURRE MD

MEDICARE: JORGE ALBERTO VIDAURRE 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	2084A0401X	Addiction Medicine (Psychiatry & Neurology) Physician	35087257	OH
2	2084N0600X	Clinical Neurophysiology Physician	35087257	OH
3	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	35087257	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4177661	OTHER	OH	CGS - MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1699736165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORGE ALBERTO VIDAURRE MD

Provider Business Mailing Address
First Line	:	555 S 18TH ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43205-2696
Country	:	US
Telephone Number	:	614-722-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	555 S 18TH ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43205-2696
Country	:	US
Telephone Number	:	614-722-6200
Fax Number	:

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

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	11/30/2022

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Directions to “ JORGE ALBERTO VIDAURRE MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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