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NPI Code Detail

MEDICARE: ROSALIE FERMO ULLOM MD

MEDICARE: ROSALIE FERMO ULLOM MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207L00000XAnesthesiology Physician35074570OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1053311456
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROSALIE FERMO ULLOM MD
Provider Business Mailing Address
First Line : 11490 SPRINGFIELD PIKE
Second Line :
City : CINCINNATI
State : OH
Zip : 45246-3524
Country : US
Telephone Number : 513-672-3309
Fax Number : 513-672-3323
Provider Business Practice Location Address
First Line : 401 N EWING ST
Second Line :
City : LANCASTER
State : OH
Zip : 43130-3372
Country : US
Telephone Number : 513-672-3309
Fax Number : 513-672-3323
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2005
Last Update Date : 07/08/2007

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Directions to “ ROSALIE FERMO ULLOM MD” Practice Location

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