Provider Demographics
NPI:1841258274
Name:TALBOT, KATHLEEN ELLEN (MD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ELLEN
Last Name:TALBOT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:KATHLEEN
Other - Middle Name:ELLEN
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:2780 AIRPORT DR STE 100
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-2289
Mailing Address - Country:US
Mailing Address - Phone:614-859-1906
Mailing Address - Fax:614-645-5517
Practice Address - Street 1:1500 E 17TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-1002
Practice Address - Country:US
Practice Address - Phone:614-645-2700
Practice Address - Fax:614-645-5517
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2019-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.053141207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1801807870OtherLODI COMMUNITY HOSPITAL TYPE 2 NPI #
OH2396081OtherLODI COMMUNITY HOSPITAL MEDICAID GROUP #
OH1003849910OtherLODI COMMUNITY CARE CENTER TYPE 2 NPI #
OH3613031OtherLODI COMMUNITY HOSPITAL MEDICARE GROUP #
OH0627815Medicaid
OH2396081OtherLODI COMMUNITY HOSPITAL MEDICAID GROUP #
OH1801807870OtherLODI COMMUNITY HOSPITAL TYPE 2 NPI #