Provider Demographics
NPI:1851366397
Name:FUSCO, JEFFREY G (DO)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:G
Last Name:FUSCO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5450 FRANTZ RD STE 360
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-4141
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4343 ALL SEASONS DR STE 220
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-1962
Practice Address - Country:US
Practice Address - Phone:614-544-1100
Practice Address - Fax:614-544-1101
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH34008201207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2486840Medicaid
OHI03707Medicare UPIN
OH2486840Medicaid