Individual
AMANDA R FANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4895 OLENTANGY RIVER RD STE 250, COLUMBUS, OH 43214-1184
(614) 267-8371
(614) 262-0005
Mailing address
4895 OLENTANGY RIVER RD. STE 250, COLUMBUS, OH 43214-1184
(614) 267-8371
(614) 262-0005
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
35130599
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0214594
—
OH
Enumeration date
04/03/2012
Last updated
03/30/2018
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