Basic Information
| Provider Information | |||||||||
| NPI: | 1285675868 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PRESCOTT | ||||||||
| FirstName: | DAVID | ||||||||
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| Mailing Information | |||||||||
| Address1: | 355 E CAMPUS VIEW BLVD | ||||||||
| Address2: | STE 180 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432355616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148401688 | ||||||||
| FaxNumber: | 6148401689 | ||||||||
| Practice Location | |||||||||
| Address1: | 355 E CAMPUS VIEW BLVD | ||||||||
| Address2: | STE 180 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432355616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148401688 | ||||||||
| FaxNumber: | 6148401689 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 11/14/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35.047519 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0537940 | 05 | OH | MEDICAID |