Provider Demographics
NPI:1851302079
Name:GIRVIN, JAMES REEDER (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:REEDER
Last Name:GIRVIN
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 1:700 BROOKSEDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-2820
Mailing Address - Country:US
Mailing Address - Phone:614-882-9338
Mailing Address - Fax:614-882-3401
Practice Address - Street 1:700 BROOKSEDGE BLVD
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-2820
Practice Address - Country:US
Practice Address - Phone:614-882-9338
Practice Address - Fax:614-882-3401
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350594252084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0716635Medicare ID - Type Unspecified