Organization
EASTGLEN PEDIATRICS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
L. ROBERT POLSTER M.D. (PRESIDENT)
(614) 866-8077
Entity
Organization
Contact information
Practice address
6495 E BROAD ST, SUITE A, COLUMBUS, OH 43213-1541
(614) 866-8077
(614) 866-9752
Mailing address
6495 E BROAD ST, SUITE A, COLUMBUS, OH 43213-1541
(614) 866-8077
(614) 866-9752
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
35031032
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0222244
—
OH
Enumeration date
02/13/2007
Last updated
08/22/2020
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