Provider Demographics
NPI:1053354712
Name:TROUT, WAYNE C (MD)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:C
Last Name:TROUT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-3069
Mailing Address - Fax:614-685-0256
Practice Address - Street 1:160 W WILSON BRIDGE RD STE 2101
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-2688
Practice Address - Country:US
Practice Address - Phone:614-293-3069
Practice Address - Fax:614-685-0256
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35062789207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0874040Medicaid
OHTR0764623Medicare PIN
OH0874040Medicaid