MEDICARE: TODD DAVID TROY PA-C

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	363AM0700X	Medical Physician Assistant	50.003518RX	OH
2	363AS0400X	Surgical Physician Assistant	50.003518	OH
3	363A00000X	Physician Assistant	50.003518RX	OH

General Provider Information

NPI Number	:	1790732188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TODD DAVID TROY PA-C

Provider Business Mailing Address
First Line	:	700 ACKERMAN RD STE 2120
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43202-1559
Country	:	US
Telephone Number	:	614-383-7660
Fax Number	:	614-383-7665

Provider Business Practice Location Address
First Line	:	445 ROCKY FORK BLVD
Second Line	:
City	:	GAHANNA
State	:	OH
Zip	:	43230-3336
Country	:	US
Telephone Number	:	614-383-7660
Fax Number	:	614-383-7665

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

Provider Enumeration Date	:	05/30/2006
Last Update Date	:	08/21/2025

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Directions to “ TODD DAVID TROY PA-C” Practice Location

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