Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 35037450B | OH |
NPI | 1104888403 |
---|---|
Provider Name | Abner H Bagenstose |
First Address | Columbus, OH 43220-2967 |
Second Address | Columbus, OH 43214-2300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2006 |
Last Update Date | 20/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0395620 | (05) | OH |
A14931 | (02) |