Provider Demographics
NPI:1720201114
Name:PADBERG, J ROBERT (PHD)
Entity Type:Individual
Prefix:DR
First Name:J
Middle Name:ROBERT
Last Name:PADBERG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1570 FISHINGER RD
Mailing Address - Street 2:
Mailing Address - City:UPPER ARLINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43221-2114
Mailing Address - Country:US
Mailing Address - Phone:614-451-2771
Mailing Address - Fax:614-451-4117
Practice Address - Street 1:1570 FISHINGER RD
Practice Address - Street 2:
Practice Address - City:UPPER ARLINGTON
Practice Address - State:OH
Practice Address - Zip Code:43221-2114
Practice Address - Country:US
Practice Address - Phone:614-451-2771
Practice Address - Fax:614-451-4117
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5207103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCENTRAL BENEFITSOther311488215000
OH6149691OtherUNITED HEALTHCARE
OH2000588Medicaid
OHMEDICAL MUTUALOther311488215001
OH000000121035OtherANTHEM
OHG10320OtherMOUNT CARMEL BEHAVIORAL
OH0005665515OtherAETNA
OHMEDICAL MUTUALOther311488215001
OHCENTRAL BENEFITSOther311488215000