1336262948 NPI number — DEAN L COLWELL DO

Table of content: DEAN L COLWELL DO (NPI 1336262948)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336262948 NPI number — DEAN L COLWELL DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLWELL
Provider First Name:
DEAN
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336262948
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1299 OLENTANGY RIVER RD
Provider Second Line Business Mailing Address:
#103
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43212-3135
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-566-4278
Provider Business Mailing Address Fax Number:
614-566-5424

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5100 W BROAD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43228-1607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-544-2061
Provider Business Practice Location Address Fax Number:
614-544-1750
Provider Enumeration Date:
04/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  34002029 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0311602 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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