Provider Demographics
NPI:1073753794
Name:CENTRAL OHIO GERIATRICS LLC
Entity Type:Organization
Organization Name:CENTRAL OHIO GERIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:WEIGAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-531-7444
Mailing Address - Street 1:PO BOX 378
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43023-0378
Mailing Address - Country:US
Mailing Address - Phone:888-531-7444
Mailing Address - Fax:888-531-7444
Practice Address - Street 1:590 NEWARK GRANVILLE RD
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:OH
Practice Address - Zip Code:43023-1436
Practice Address - Country:US
Practice Address - Phone:888-531-7444
Practice Address - Fax:888-531-7444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-21
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-060271207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2968267Medicaid
OH2968267Medicaid