Healthcare Provider Details

I. General information

NPI: 1467764258
Provider Name (Legal Business Name): PAUL G QUERTERMOUS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2010
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

682 HAWTHORNE AVE
CINCINNATI OH
45205-2398
US

IV. Provider business mailing address

682 HAWTHORNE AVE
CINCINNATI OH
45205-2398
US

V. Phone/Fax

Practice location:
  • Phone: 513-921-1613
  • Fax: 513-921-1613
Mailing address:
  • Phone: 513-921-1613
  • Fax: 513-921-4244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2507548
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.162897
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number299499
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: