Provider Demographics
NPI:1700081353
Name:ACKAH, ERIC (MD, PHD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:ACKAH
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5450 FRANTZ RD STE 360
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-4141
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1010 REFUGEE RD
Practice Address - Street 2:SUITE 310
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-9653
Practice Address - Country:US
Practice Address - Phone:614-533-5000
Practice Address - Fax:614-533-0101
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH31.126175207RC0000X
MAL-232239207R00000X
CT050512208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH351080Medicare PIN