Provider Demographics
NPI:1467595819
Name:FRADKIN, HOWARD ROSS (PHD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:ROSS
Last Name:FRADKIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 S FRONT ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43206-2521
Mailing Address - Country:US
Mailing Address - Phone:614-445-8277
Mailing Address - Fax:614-445-8283
Practice Address - Street 1:918 S FRONT ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43206-2521
Practice Address - Country:US
Practice Address - Phone:614-445-8277
Practice Address - Fax:614-445-8283
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH933439101YA0400X
OH3237103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2070860Medicaid
OH2070860Medicaid
OHCP03851Medicare ID - Type Unspecified