Provider Demographics
NPI:1164712147
Name:TALATI, MANSI D
Entity Type:Individual
Prefix:
First Name:MANSI
Middle Name:D
Last Name:TALATI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MANSI
Other - Middle Name:D
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD
Mailing Address - Street 2:SUITE 570
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-8116
Mailing Address - Fax:614-293-3555
Practice Address - Street 1:915 OLENTANGY RIVER RD
Practice Address - Street 2:5TH FLOOR
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-3153
Practice Address - Country:US
Practice Address - Phone:614-293-8116
Practice Address - Fax:614-293-3555
Is Sole Proprietor?:No
Enumeration Date:2011-04-12
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35126412207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0135399Medicaid
OH0135399Medicaid