Provider Demographics
NPI:1134120678
Name:THURBER, NOEL BERNARD (DPM)
Entity Type:Individual
Prefix:DR
First Name:NOEL
Middle Name:BERNARD
Last Name:THURBER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 COPELAND MILL RD
Mailing Address - Street 2:SUITE 2F
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-8977
Mailing Address - Country:US
Mailing Address - Phone:614-891-2828
Mailing Address - Fax:614-891-5411
Practice Address - Street 1:575 COPELAND MILL RD
Practice Address - Street 2:2F
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8977
Practice Address - Country:US
Practice Address - Phone:614-891-2828
Practice Address - Fax:614-891-5411
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002522213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH480032334OtherRAILROAD MEDICARE
P00070528OtherRAILROAD MEDICARE
OH4649800001OtherADMINASTAR
OH0835958Medicaid
OH4778110001OtherADMINASTAR
OH36002522OtherSTATE LICENSE#
OHP00064303OtherRAILROAD MEDICARE
OH000000211132OtherANTHEM
OH000000316937OtherANTHEM
OH030507736027OtherCARESOURE
OH311795350029OtherCARESOURCE
OHP00064303OtherRAILROAD MEDICARE
OH36002522OtherSTATE LICENSE#
OHTH0624394Medicare PIN