Provider Demographics
NPI:1770567232
Name:KING, JOAN E (DO)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:E
Last Name:KING
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4895 OLENTANGY RIVER RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-1926
Mailing Address - Country:US
Mailing Address - Phone:614-326-1502
Mailing Address - Fax:614-326-3011
Practice Address - Street 1:4895 OLENTANGY RIVER RD
Practice Address - Street 2:SUITE 200
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214
Practice Address - Country:US
Practice Address - Phone:614-326-1502
Practice Address - Fax:614-326-3011
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH34-00-5020207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0836457Medicaid
OHE87018Medicare UPIN
OH0836457Medicaid