Provider Demographics
NPI:1720083736
Name:WURST, ANN MARIE (MD)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:WURST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 JASONWAY AVE STE B
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-2456
Mailing Address - Country:US
Mailing Address - Phone:614-268-8800
Mailing Address - Fax:614-447-8876
Practice Address - Street 1:921B JASONWAY AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-2330
Practice Address - Country:US
Practice Address - Phone:614-268-8800
Practice Address - Fax:614-447-8876
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.054481207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0672740Medicaid
OH0672740Medicaid
OHE54218Medicare UPIN