Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 35053986 | OH |
NPI | 1043226525 |
---|---|
Provider Name | Susan L Koletar |
First Address | Columbus, OH 43202-1559 |
Second Address | Columbus, OH 43210-1257 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 21/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0702814 | (05) | OH |