Provider Demographics
NPI:1255796025
Name:ROOT, DONALD III (NP-C)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:
Last Name:ROOT
Suffix:III
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 POLARIS PKWY STE 1100
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-7277
Mailing Address - Country:US
Mailing Address - Phone:614-533-3400
Mailing Address - Fax:
Practice Address - Street 1:300 POLARIS PKWY STE 1100
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-7277
Practice Address - Country:US
Practice Address - Phone:614-533-3400
Practice Address - Fax:614-533-3425
Is Sole Proprietor?:No
Enumeration Date:2015-12-22
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.18502363LF0000X, 363LX0106X
OHCOA.18502-NP363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care