MEDICARE: DR. RODNEY E. VIVIAN M.D.

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
1	2084P0800X	Psychiatry Physician	35041575	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000011245	OTHER	OH	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	036793000	OTHER	OH	MAGELLAN

General Provider Information

NPI Number	:	1295763845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RODNEY E. VIVIAN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 635283
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-5283
Country	:	US
Telephone Number	:	859-301-5901
Fax Number	:	859-301-5940

Provider Business Practice Location Address
First Line	:	4452 EASTGATE BLVD STE 202
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45245-1584
Country	:	US
Telephone Number	:	513-232-3070
Fax Number	:	513-232-5794

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	01/06/2023

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