Provider Demographics
NPI:1669625265
Name:ANNE THERESE AESTHETIC MEDICINE
Entity type:Organization
Organization Name:ANNE THERESE AESTHETIC MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:T
Authorized Official - Last Name:STUBBS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-855-4411
Mailing Address - Street 1:438 BEECHER RD
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-1797
Mailing Address - Country:US
Mailing Address - Phone:614-855-4411
Mailing Address - Fax:614-855-4452
Practice Address - Street 1:438 BEECHER RD
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-1797
Practice Address - Country:US
Practice Address - Phone:614-855-4411
Practice Address - Fax:614-855-4452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-062446174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty