Provider Demographics
NPI:1255334090
Name:NADALIN, RICHARD (DPM)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:NADALIN
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:PO BOX 30977
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-0977
Mailing Address - Country:US
Mailing Address - Phone:614-428-7701
Mailing Address - Fax:
Practice Address - Street 1:453 WATERBURY CT
Practice Address - Street 2:STE 200
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-5309
Practice Address - Country:US
Practice Address - Phone:614-428-7701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36001683213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0307877Medicaid
OH791480057AOtherRAILROAD MEDICARE
OH791480057AOtherRAILROAD MEDICARE
OH0307877Medicaid