Provider Demographics
NPI:1942478110
Name:RIVERSIDE NEPHROLOGY ASOCIATES, INC.
Entity Type:Organization
Organization Name:RIVERSIDE NEPHROLOGY ASOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF OSTEOPATHIC MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:CHELLINI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:614-538-2250
Mailing Address - Street 1:500 THOMAS LN
Mailing Address - Street 2:4A
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-1419
Mailing Address - Country:US
Mailing Address - Phone:614-538-2250
Mailing Address - Fax:
Practice Address - Street 1:500 THOMAS LN
Practice Address - Street 2:4A
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-1419
Practice Address - Country:US
Practice Address - Phone:614-538-2250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008433207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty