Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 2630 | OH |
NPI | 1427257401 |
---|---|
Provider Name | Dr. Kelly Lynn Podlosky |
First Address | Columbus, OH 43212-2671 |
Second Address | Columbus, OH 43210 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2007 |
Last Update Date | 11/07/2007 |