Basic Information
| Provider Information | |||||||||
| NPI: | 1003983743 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GORSLINE | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | TODD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3777 TRUEMAN CT | ||||||||
| Address2: | |||||||||
| City: | HILLIARD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430262496 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144881816 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3777 TRUEMAN CT | ||||||||
| Address2: | |||||||||
| City: | HILLIARD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430262496 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144881816 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2006 | ||||||||
| LastUpdateDate: | 06/01/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 35082522 | OH | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XX0004X | 35082522 | OH | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Foot and Ankle Surgery |
ID Information
| ID | Type | State | Issuer | Description | 4421123 | 01 | OH | AETNA | OTHER | 000000578479 | 01 | ANTHEM | OTHER |