Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 34014698 | OH |
Y | 207QS0010X | Family Doctor - Sports Medicine | 34014698 | OH |
NPI | 1184078644 |
---|---|
Provider Name | Margaret Doe |
First Address | Columbus, OH 43203-1278 |
Second Address | Columbus, OH 43203-1278 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2016 |
Last Update Date | 16/11/2020 |