Provider Demographics
NPI:1609979566
Name:DAVID G. STOCKWELL, M.D. INC
Entity Type:Organization
Organization Name:DAVID G. STOCKWELL, M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCHMALTZ
Authorized Official - Suffix:
Authorized Official - Credentials:RNC
Authorized Official - Phone:614-262-9490
Mailing Address - Street 1:3545 OLENTANGY RIVER RD
Mailing Address - Street 2:SUITE 411
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3993
Mailing Address - Country:US
Mailing Address - Phone:614-262-3144
Mailing Address - Fax:614-262-3155
Practice Address - Street 1:3545 OLENTANGY RIVER RD
Practice Address - Street 2:SUITE 411
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3993
Practice Address - Country:US
Practice Address - Phone:614-262-3144
Practice Address - Fax:614-262-3155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35036392S207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2117328Medicaid
OH0378694Medicaid
OH2117328Medicaid
OHA76292Medicare UPIN
OH9296301Medicare ID - Type UnspecifiedGROUP PROVIDER #