Healthcare Provider Details

I. General information

NPI: 1184617946
Provider Name (Legal Business Name): BETH E HABERMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 07/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE ML 7009
CINCINNATI OH
45229-3039
US

IV. Provider business mailing address

3333 BURNET AVE ML 7009
CINCINNATI OH
45229-3039
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4830
  • Fax: 513-636-7868
Mailing address:
  • Phone: 513-636-4830
  • Fax: 513-636-7868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number36541
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number36541
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number36541
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number35067806
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: