Provider Demographics
NPI:1689905150
Name:CO FAUSTINO, GENEVIEVE TAN (MD)
Entity Type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:TAN
Last Name:CO FAUSTINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GENEVIEVE
Other - Middle Name:TAN
Other - Last Name:CO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4310 CLIME RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-3496
Mailing Address - Country:US
Mailing Address - Phone:614-274-7799
Mailing Address - Fax:614-274-3209
Practice Address - Street 1:4310 CLIME RD
Practice Address - Street 2:SUITE B
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-3496
Practice Address - Country:US
Practice Address - Phone:614-274-7799
Practice Address - Fax:614-274-3209
Is Sole Proprietor?:No
Enumeration Date:2010-01-24
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD440857207R00000X
OH35-122566207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine