Provider Demographics
NPI:1679770481
Name:OHIO STATE UNIVERSITY
Entity Type:Organization
Organization Name:OHIO STATE UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSOR OF CLINICAL PATHOLOGY
Authorized Official - Prefix:PROF
Authorized Official - First Name:SEDIGHEH
Authorized Official - Middle Name:
Authorized Official - Last Name:KEYHANI-ROFAGHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-293-0408
Mailing Address - Street 1:1958 STRATHSHIRE HALL LN
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-9437
Mailing Address - Country:US
Mailing Address - Phone:614-888-6943
Mailing Address - Fax:614-888-6943
Practice Address - Street 1:1958 STRATHSHIRE HALL LANE
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065
Practice Address - Country:US
Practice Address - Phone:614-293-0408
Practice Address - Fax:614-293-3587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.049786291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH78055821OtherPATHOLOGIST