MEDICARE: ANGELA M WEATHERWAX PA

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	50-002174	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	:	1861486961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA M WEATHERWAX PA

Provider Business Mailing Address
First Line	:	5350 FRANTZ RD
Second Line	:
City	:	DUBLIN
State	:	OH
Zip	:	43016-4259
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3555 OLENTANGY RIVER RD
Second Line	:	SUITE 2050
City	:	COLUMBUS
State	:	OH
Zip	:	43214-3912
Country	:	US
Telephone Number	:	614-566-2450
Fax Number	:	614-566-1895

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

Provider Enumeration Date	:	09/02/2005
Last Update Date	:	11/25/2025

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Directions to “ ANGELA M WEATHERWAX PA” Practice Location

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