1508858515 NPI number — DR. GREGORY S STOCKFISH D.P.M.,F.A.C.F.A.S

Table of content: DR. GREGORY S STOCKFISH D.P.M.,F.A.C.F.A.S (NPI 1508858515)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508858515 NPI number — DR. GREGORY S STOCKFISH D.P.M.,F.A.C.F.A.S

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STOCKFISH
Provider First Name:
GREGORY
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.,F.A.C.F.A.S
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:
1508858515
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
575 COPELAND MILL RD
Provider Second Line Business Mailing Address:
SUITE 2F
Provider Business Mailing Address City Name:
WESTERVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43081-8977
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-891-2828
Provider Business Mailing Address Fax Number:
614-891-5411

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
575 COPELAND MILL RD
Provider Second Line Business Practice Location Address:
SUITE 2F
Provider Business Practice Location Address City Name:
WESTERVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43081-8977
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-891-2828
Provider Business Practice Location Address Fax Number:
614-891-5411
Provider Enumeration Date:
08/16/2005

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: 213E00000X , with the licence number:  36002387 , 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: 0707702 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 311795350030 . This is a "CARESOURCE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000211119 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 4649800001 . This is a "ADMINASTAR" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 4778110001 . This is a "ADMINASTAR" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 030507736028 . This is a "CARESOURCE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 480035261 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000273180 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 480032425 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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