MEDICARE: DR. ALFREDO NICODEMUS RIVERA 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
1	2084P0800X	Psychiatry Physician	36592	KY
2	2084P0800X	Psychiatry Physician	35-068271	OH
3	2084P0805X	Geriatric Psychiatry Physician	36592	KY
4	2084P0805X	Geriatric Psychiatry Physician	35-068271	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	260049430	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1811081334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALFREDO NICODEMUS RIVERA MD

Provider Business Mailing Address
First Line	:	4760 RED BANK RD
Second Line	:	STE 217
City	:	CINCINNATI
State	:	OH
Zip	:	45227-1548
Country	:	US
Telephone Number	:	513-297-4070
Fax Number	:	513-297-4070

Provider Business Practice Location Address
First Line	:	4760 RED BANK RD
Second Line	:	STE 217
City	:	CINCINNATI
State	:	OH
Zip	:	45227-1548
Country	:	US
Telephone Number	:	513-297-4070
Fax Number	:	513-297-4070

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	01/27/2022

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