Provider Demographics
NPI:1023091113
Name:FANKHAUSER, RICHARD ALLEN (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALLEN
Last Name:FANKHAUSER
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 1:815 W BROAD ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43222-1548
Mailing Address - Country:US
Mailing Address - Phone:614-228-4262
Mailing Address - Fax:614-228-6582
Practice Address - Street 1:815 W BROAD ST
Practice Address - Street 2:SUITE 300
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43222-1548
Practice Address - Country:US
Practice Address - Phone:614-228-4262
Practice Address - Fax:614-228-6582
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0980404207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0485863Medicaid
OH0900871OtherDMERC
OHA80339Medicare UPIN
OH0900871OtherDMERC
OH0485863Medicaid