Healthcare Provider Details

I. General information

NPI: 1396763041
Provider Name (Legal Business Name): SUZANNE WEINRICH OGDEN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3085 LAKECREST CIR
LEXINGTON KY
40513-1707
US

IV. Provider business mailing address

3085 LAKECREST CIR
LEXINGTON KY
40513-1707
US

V. Phone/Fax

Practice location:
  • Phone: 859-258-8600
  • Fax: 859-885-8448
Mailing address:
  • Phone: 859-258-8600
  • Fax: 859-258-5610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02487
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: