Provider Demographics
NPI:1225677750
Name:COLATRUGLIO, KERRY
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:COLATRUGLIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1216 SUNBURY RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-2099
Mailing Address - Country:US
Mailing Address - Phone:614-251-8988
Mailing Address - Fax:
Practice Address - Street 1:1216 SUNBURY RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-2099
Practice Address - Country:US
Practice Address - Phone:614-251-8988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-01
Last Update Date:2020-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant