Provider Demographics
NPI:1821224767
Name:DRUMMOND, JUSTIN THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:THOMAS
Last Name:DRUMMOND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 N MEADOWS DR STE 120
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-7688
Mailing Address - Country:US
Mailing Address - Phone:614-663-3501
Mailing Address - Fax:614-663-3525
Practice Address - Street 1:5500 N MEADOWS DR STE 120
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-7688
Practice Address - Country:US
Practice Address - Phone:614-663-3501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-05
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.120966207L00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0109034Medicaid
12738578OtherCAQH
OH0109034Medicaid