Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RR0500X | Rheumatology | 35075002 | OH |
Y | 2080P0216X | Pediatric Rheumatologist | 35075002 | OH |
NPI | 1417971086 |
---|---|
Provider Name | Stacy Payne Ardoin |
First Address | Columbus, OH 43205-2664 |
Second Address | Columbus, OH 43205-2664 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 10/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2246608 | (05) | OH |
H138151 | CGS - MEDICARE (01) | OH |
H138151-OSU | CGS - MEDICARE (01) | OH |