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NPI Code Detail

MEDICARE: GAIL L BONGIOVANNI M.D.

MEDICARE:   GAIL L BONGIOVANNI  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
1207RG0100XGastroenterology Physician35-047633OH

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1100010945OTHEROHRAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number : 1891799441
Entity Type Code : Individual
Provider Name (Legal Business Name) : GAIL L BONGIOVANNI M.D.
Provider Business Mailing Address
First Line : PO BOX 636256
Second Line : CENTRAL CREDENTIALING
City : CINCINNATI
State : OH
Zip : 45263-6256
Country : US
Telephone Number : 513-585-5507
Fax Number : 513-585-5511
Provider Business Practice Location Address
First Line : 3590 LUCILLE DR
Second Line :
City : CINCINNATI
State : OH
Zip : 45213-2674
Country : US
Telephone Number : 513-475-7505
Fax Number : 513-475-7355
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2005
Last Update Date : 07/10/2017

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Directions to “ GAIL L BONGIOVANNI M.D.” Practice Location

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