Provider Demographics
NPI:1679149520
Name:COLOMBO, ERIC (RD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:COLOMBO
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2945 WELSFORD RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-2834
Mailing Address - Country:US
Mailing Address - Phone:614-725-9071
Mailing Address - Fax:
Practice Address - Street 1:2945 WELSFORD RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-2834
Practice Address - Country:US
Practice Address - Phone:614-725-9071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH86146294133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered