Organization
DONE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CREDENTIALING DEPARTMENT (OFFICE MANAGER/BUSINESS STAFF)
(888) 291-5143
Entity
Organization
Contact information
Practice address
545 METRO PL S STE 100, DUBLIN, OH 43017-5353
(888) 291-5143
Mailing address
545 METRO PL S STE 100, DUBLIN, OH 43017-5353
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
35C-000658
MD
OH
Enumeration date
11/06/2023
Last updated
11/16/2023
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