Provider Demographics
NPI:1982947925
Name:DIBARTOLA, MICHAEL T (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:T
Last Name:DIBARTOLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4885 OLENTANGY RIVER RD
Mailing Address - Street 2:SUITE 2-10
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-1993
Mailing Address - Country:US
Mailing Address - Phone:614-267-7878
Mailing Address - Fax:614-267-7077
Practice Address - Street 1:4885 OLENTANGY RIVER RD
Practice Address - Street 2:SUITE 2-10
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-1993
Practice Address - Country:US
Practice Address - Phone:614-267-7878
Practice Address - Fax:614-267-7077
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-125353208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0161813Medicaid