Basic Information
Provider Information | |||||||||
NPI: | 1164712147 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | TALATI | ||||||||
FirstName: | MANSI | ||||||||
MiddleName: | D. | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | PATEL | ||||||||
OtherFirstName: | MANSI | ||||||||
OtherMiddleName: | D. | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 700 ACKERMAN RD | ||||||||
Address2: | SUITE 570 | ||||||||
City: | COLUMBUS | ||||||||
State: | OH | ||||||||
PostalCode: | 432021559 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6142938116 | ||||||||
FaxNumber: | 6142933555 | ||||||||
Practice Location | |||||||||
Address1: | 915 OLENTANGY RIVER RD | ||||||||
Address2: | 5TH FLOOR | ||||||||
City: | COLUMBUS | ||||||||
State: | OH | ||||||||
PostalCode: | 432123153 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6142938116 | ||||||||
FaxNumber: | 6142933555 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/12/2011 | ||||||||
LastUpdateDate: | 11/25/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 35126412 | OH | Y |   | Allopathic & Osteopathic Physicians | Ophthalmology |   |
ID Information
ID | Type | State | Issuer | Description | 0135399 | 05 | OH |   | MEDICAID |