Individual
LISA P. FUGATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
480 MEDICAL CENTER DR, COLUMBUS, OH 43210
(614) 293-7604
(614) 293-3809
Mailing address
700 ACKERMAN RD STE 385, COLUMBUS, OH 43202-1524
(614) 947-3700
(614) 947-3771
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
35062775F
OH
2081P0004X
Spinal Cord Injury Medicine Physician
35.06.2755
OH
2083P0901X
Public Health & General Preventive Medicine Physician
35.06.2775
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2025418
—
OH
Enumeration date
09/27/2006
Last updated
11/26/2012
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