Provider Demographics
NPI:1619903879
Name:TRAUGOTT, AMBER L (MD)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:L
Last Name:TRAUGOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-3230
Mailing Address - Fax:614-293-4030
Practice Address - Street 1:1800 ZOLLINGER RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-2849
Practice Address - Country:US
Practice Address - Phone:614-293-3230
Practice Address - Fax:614-293-4030
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35126459208C00000X, 208C00000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP01718233OtherRAILROAD MEDICARE
OH0133058Medicaid
OHP01718233OtherRAILROAD MEDICARE