Provider Demographics
NPI:1104912914
Name:COLE-SEDIVY, DEBORAH L (DO)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:L
Last Name:COLE-SEDIVY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3260 W. HENDERSON ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220
Mailing Address - Country:US
Mailing Address - Phone:614-545-2002
Mailing Address - Fax:614-545-7546
Practice Address - Street 1:3260 W. HENDERSON ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220
Practice Address - Country:US
Practice Address - Phone:614-545-2002
Practice Address - Fax:614-545-7546
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-004212207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0748383Medicaid
E29845Medicare UPIN
OH0748383Medicaid