Healthcare Provider Details

I. General information

NPI: 1790733897
Provider Name (Legal Business Name): RACHEL ELIZABETH GUSTIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 09/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 E GALBRAITH RD SUITE 105
CINCINNATI OH
45236-2754
US

IV. Provider business mailing address

4700 E GALBRAITH RD SUITE 105
CINCINNATI OH
45236-2754
US

V. Phone/Fax

Practice location:
  • Phone: 513-924-8860
  • Fax: 513-924-8861
Mailing address:
  • Phone: 513-924-8860
  • Fax: 513-924-8861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number35.098325
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: