Organization
COLONNADE MEDICAL GROUP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROLE REYNOLDS (OFFICE MGR)
(740) 654-0232
Entity
Organization
Contact information
Practice address
1550 SHERIDAN DR, SUITE 202, LANCASTER, OH 43130-1380
(740) 654-0232
Mailing address
1550 SHERIDAN DR, SUITE 202, LANCASTER, OH 43130-1380
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
10/05/2006
Last updated
09/05/2007
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