Provider Demographics
NPI:1912381161
Name:CZOMPOLY, BRIDGET FAWN
Entity type:Individual
Prefix:MS
First Name:BRIDGET
Middle Name:FAWN
Last Name:CZOMPOLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2469 STELZER RD
Mailing Address - Street 2:BRADFORD SCHOOL
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-0037
Mailing Address - Country:US
Mailing Address - Phone:614-416-6200
Mailing Address - Fax:
Practice Address - Street 1:1365 NICHOLS AVE
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-1039
Practice Address - Country:US
Practice Address - Phone:440-822-7898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-17
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program