Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 35120378 | OH |
N | 207P00000X | Emergency Physician | 4301099402 | MI |
NPI | 1003075136 |
---|---|
Provider Name | Lauren Talanda-Fath Southerland |
First Address | Columbus, OH 43210-1280 |
Second Address | Columbus, OH 43210-1240 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2008 |
Last Update Date | 06/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0076553 | (05) | OH |