1407844970 NPI number — CHRISTINA BOHNERT LOPEZ MD

Table of content: CHRISTINA BOHNERT LOPEZ MD (NPI 1407844970)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407844970 NPI number — CHRISTINA BOHNERT LOPEZ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOPEZ
Provider First Name:
CHRISTINA
Provider Middle Name:
BOHNERT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BONHERT
Provider Other First Name:
CHRISTINA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1407844970
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5400 FRANTZ RD
Provider Second Line Business Mailing Address:
SUITE 250
Provider Business Mailing Address City Name:
DUBLIN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43016-4144
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7340 E BROAD ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
BLACKLICK
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43004-9625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-864-8000
Provider Business Practice Location Address Fax Number:
614-864-3036
Provider Enumeration Date:
10/10/2005

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: 207Q00000X , with the licence number:  35079989 , 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: 2323177 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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