Individual
MARETTA FAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
700 CHILDRENS DR, COLUMBUS, OH 43205-2664
(614) 722-6200
Mailing address
700 CHILDRENS DR, COLUMBUS, OH 43205-2664
(614) 722-2000
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
34.015575
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0483764
—
OH
01
—
H899970
CGS - MEDICARE
OH
Enumeration date
04/16/2019
Last updated
03/11/2026
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