Provider Demographics
NPI:1821056144
Name:SKINNER, CARMEN R (DO)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:R
Last Name:SKINNER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-366-7500
Mailing Address - Fax:
Practice Address - Street 1:2050 KENNY RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-3502
Practice Address - Country:US
Practice Address - Phone:614-366-7500
Practice Address - Fax:614-366-7560
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH340073365207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000329030OtherANTHEM
287687080OtherCHAMPUS
311098079OtherPPO NEXT
OH2179995Medicaid
0409223OtherUHC
311098079OtherCIGNA
P00139304OtherTRAVELERS MEDICARE
7624112OtherAETNA
0409223OtherUHC
7624112OtherAETNA
287687080OtherCHAMPUS