Provider Demographics
NPI:1548245566
Name:STARPATH ORTHOPAEDICS & SPORTS MEDICINE, INC.
Entity Type:Organization
Organization Name:STARPATH ORTHOPAEDICS & SPORTS MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROSENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-220-0398
Mailing Address - Street 1:7277 SMITHS MILL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054
Mailing Address - Country:US
Mailing Address - Phone:614-220-0398
Mailing Address - Fax:614-221-6301
Practice Address - Street 1:7277 SMITHS MILL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054
Practice Address - Country:US
Practice Address - Phone:614-220-0398
Practice Address - Fax:614-221-6301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2421776Medicaid
OHST9335361Medicare UPIN