Individual
JEREMY WACHENSCHWANZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
3535 OLENTANGY RIVER RD, COLUMBUS, OH 43214-3998
(614) 566-5000
Mailing address
3600 FORBES AVENUE, FORBES TOWER - PLAZA LEVEL SUITE 140, PITTSBURGH, PA 15213
(330) 363-6267
(330) 363-2485
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
AP2282058A13
OH
2085R0202X
Diagnostic Radiology Physician
Primary
34.011121
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0116167
—
OH
Enumeration date
05/31/2012
Last updated
09/12/2019
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