Basic Information
| Provider Information | |||||||||
| NPI: | 1679568372 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FADA | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 303 E TOWN ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432154601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6147885000 | ||||||||
| FaxNumber: | 6147885100 | ||||||||
| Practice Location | |||||||||
| Address1: | 303 E TOWN ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432154601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6147885000 | ||||||||
| FaxNumber: | 6147885100 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2005 | ||||||||
| LastUpdateDate: | 12/22/2021 | ||||||||
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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 | 207X00000X | 35.070263 | OH | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XS0114X | 35070263 | OH | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Adult Reconstructive Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 2012048 | 05 | OH | MEDICAID | H476900 | 01 | OH | OPG MEDICARE | OTHER |