Provider Demographics
NPI:1043216724
Name:BALTURSHOT, GREGORY W (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:W
Last Name:BALTURSHOT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3525 OLENTANGY RIVER RD
Mailing Address - Street 2:SUITE 5310
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3937
Mailing Address - Country:US
Mailing Address - Phone:614-261-0073
Mailing Address - Fax:614-268-5611
Practice Address - Street 1:3525 OLENTANGY RIVER RD
Practice Address - Street 2:SUITE 5310
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3937
Practice Address - Country:US
Practice Address - Phone:614-261-0073
Practice Address - Fax:614-268-5611
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.075003207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2404517Medicaid
OH310874776032OtherCARESOURCE PIN
OH000000287349OtherANTHEM PIN
OH4251397001OtherCIGNA PIN
OH600450OtherUNITED HEALTHCARE
KY64090327Medicaid
OH7513476OtherAETNA PIN NUMBER
OH000000287349OtherANTHEM PIN
OH4982480003Medicare NSC
OH600450OtherUNITED HEALTHCARE
KY64090327Medicaid
OHBA4106943Medicare PIN