Healthcare Provider Details

I. General information

NPI: 1356838676
Provider Name (Legal Business Name): OREN COSTANTINI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2018
Last Update Date: 11/07/2023
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL VILLAGE DR
EDGEWOOD KY
41017-3403
US

IV. Provider business mailing address

PO BOX 632572
CINCINNATI OH
45263-2572
US

V. Phone/Fax

Practice location:
  • Phone: 859-301-2000
  • Fax: 859-341-7867
Mailing address:
  • Phone: 859-341-2666
  • Fax: 859-341-7867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number05571
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number05571
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: