Provider Demographics
NPI:1790762904
Name:WURMBRAND, JOAN E (MD)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:E
Last Name:WURMBRAND
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 1:1120 POLARIS PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43240-4042
Mailing Address - Country:US
Mailing Address - Phone:614-797-0600
Mailing Address - Fax:614-259-0610
Practice Address - Street 1:1120 POLARIS PKWY STE 110
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43240-4042
Practice Address - Country:US
Practice Address - Phone:614-797-0600
Practice Address - Fax:614-259-0610
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35-04-5407207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0460844Medicaid
OH0460844Medicaid
OHA79879Medicare UPIN