Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 35063718 | OH |
NPI | 1407841455 |
---|---|
Provider Name | Ray C. Wasielewski |
First Address | Columbus, OH 43215-4601 |
Second Address | Columbus, OH 43215 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2005 |
Last Update Date | 03/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0880355 | (05) | OH |
E91683 | (02) | OH |