Provider Demographics
NPI:1164497335
Name:HENCEROTH-GATTO, NANCY A (DO)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:A
Last Name:HENCEROTH-GATTO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5450 FRANTZ RD
Mailing Address - Street 2:STE 250
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-4134
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4191 KELNOR DR STE 300
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-3990
Practice Address - Country:US
Practice Address - Phone:614-875-6349
Practice Address - Fax:614-875-3633
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH34003011207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0466311Medicaid
OH0466311Medicaid
OHHE0503172Medicare PIN