Provider Demographics
NPI:1467059808
Name:PRUSZ, CONNOR BRADLY (PA-C)
Entity type:Individual
Prefix:
First Name:CONNOR
Middle Name:BRADLY
Last Name:PRUSZ
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6670 PERIMETER DRIVE
Mailing Address - Street 2:STE 140
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-8057
Mailing Address - Country:US
Mailing Address - Phone:614-526-2150
Mailing Address - Fax:614-526-2151
Practice Address - Street 1:6670 PERIMETER DRIVE
Practice Address - Street 2:STE 140
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-8057
Practice Address - Country:US
Practice Address - Phone:614-526-2150
Practice Address - Fax:614-526-2151
Is Sole Proprietor?:No
Enumeration Date:2020-10-08
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPENDING363A00000X
OH50.006854RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant