Provider Demographics
NPI:1083057418
Name:MCFADDEN, JONATHAN PATRICK (DO)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:PATRICK
Last Name:MCFADDEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 AFRICA RD STE 200
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-9830
Mailing Address - Country:US
Mailing Address - Phone:614-891-8080
Mailing Address - Fax:614-891-7078
Practice Address - Street 1:625 AFRICA RD STE 200
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-9830
Practice Address - Country:US
Practice Address - Phone:614-891-8080
Practice Address - Fax:614-891-7078
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-16
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.011887207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0173335Medicaid
OHH289990Medicare PIN