Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 35072294 | OH |
NPI | 1295846673 |
---|---|
Provider Name | Dr. James Glenn Fitkin |
First Address | Columbus, OH 43220-2968 |
Second Address | Columbus, OH 43220-2968 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 09/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2045834 | (05) | OH |
G58790 | (02) | OH |