Organization
CENTRAL OHIO UROLOGY GROUP, LLC
Active
Other names
Group & UA
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. NICOLE GIACOMELLI M.B.A. (DIRECTOR OF OPERATIONS)
(614) 396-2635
Entity
Organization
Contact information
Practice address
701 TECH CENTER DRIVE, SUITE 100, GAHANNA, OH 43230
(614) 396-2684
(614) 396-2480
Mailing address
701 TECH CENTER DRIVE, SUITE 250, GAHANNA, OH 43230
(614) 944-4806
(614) 944-4750
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1083883391
DMERC
OH
01
—
1144499237
DMERC
OH
01
—
1518136605
DMERC
OH
01
—
1811166986
DMERC
OH
05
—
2660820
—
OH
01
—
DF0566
RAILROAD MEDICARE
OH
Enumeration date
06/20/2006
Last updated
12/31/2018
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