Healthcare Provider Details

I. General information

NPI: 1427443480
Provider Name (Legal Business Name): ERICA R. PIVATO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2015
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 MEDICAL VILLAGE DR
EDGEWOOD KY
41017-3439
US

IV. Provider business mailing address

PO BOX 636324
CINCINNATI OH
45263-5632
US

V. Phone/Fax

Practice location:
  • Phone: 859-287-3045
  • Fax: 859-578-3800
Mailing address:
  • Phone: 859-287-3045
  • Fax: 859-578-3800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number05263
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number02006879A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number34.013560
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: