1205139391 NPI number — CARL ORTMAN M.D.

Table of content: CARL ORTMAN M.D. (NPI 1205139391)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205139391 NPI number — CARL ORTMAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ORTMAN
Provider First Name:
CARL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1205139391
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5450 FRANTZ RD STE 360
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUBLIN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43016-4141
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-544-6155
Provider Business Mailing Address Fax Number:
614-544-6370

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75 HOSPITAL DR
Provider Second Line Business Practice Location Address:
SUITE 350
Provider Business Practice Location Address City Name:
ATHENS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45701-2857
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-592-4491
Provider Business Practice Location Address Fax Number:
740-592-4844
Provider Enumeration Date:
12/10/2010

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: 207R00000X , with the licence number:  35-122404 , 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: 0095687 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: H267070 . This is a "MEDICARE PROVIDER NUMBER" identifier . This identifiers is of the category "OTHER".




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