Provider Demographics
NPI:1598704868
Name:PLACE, ANDREW ZACHARY (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:ZACHARY
Last Name:PLACE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12035 PALMER RD SW
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-3830
Mailing Address - Country:US
Mailing Address - Phone:614-730-0462
Mailing Address - Fax:
Practice Address - Street 1:10330 SAWMILL PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-7790
Practice Address - Country:US
Practice Address - Phone:614-793-2635
Practice Address - Fax:614-793-2562
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35076937207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2249598Medicaid
OH00080270OtherRAILROAD MEDICARE
OHH36788Medicare UPIN
OH2249598Medicaid