Provider Demographics
NPI:1962573808
Name:KOELLING, HEATHER CAROLINE (MD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:CAROLINE
Last Name:KOELLING
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2929 KENNY ROAD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-2415
Mailing Address - Country:US
Mailing Address - Phone:614-488-8000
Mailing Address - Fax:614-488-8610
Practice Address - Street 1:2929 KENNY ROAD
Practice Address - Street 2:SUITE 150
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-2415
Practice Address - Country:US
Practice Address - Phone:614-488-8000
Practice Address - Fax:614-488-8610
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2011-07-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35067131207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2004780Medicaid
OH2004780Medicaid
OHKO0822231Medicare PIN