Provider Demographics
NPI:1598756447
Name:KOSHAL, VIPIN BADHWAR (DO)
Entity Type:Individual
Prefix:DR
First Name:VIPIN
Middle Name:BADHWAR
Last Name:KOSHAL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 FRANTZ RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-4144
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:65 HOSPITAL DR
Practice Address - Street 2:CORNWELL CENTER
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2302
Practice Address - Country:US
Practice Address - Phone:740-566-4890
Practice Address - Fax:740-566-4891
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008010207R00000X
OH34-008010207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2440577Medicaid
4164482Medicare PIN
H97850Medicare UPIN
OH2440577Medicaid