Healthcare Provider Details

I. General information

NPI: 1740234558
Provider Name (Legal Business Name): MARY E COON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 11/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 ROBERTSON AVE
CINCINNATI OH
45209-1268
US

IV. Provider business mailing address

4750 HEMPSTEAD STATION DR
KETTERING OH
45429-5164
US

V. Phone/Fax

Practice location:
  • Phone: 513-281-4400
  • Fax:
Mailing address:
  • Phone: 800-875-0136
  • Fax: 937-619-4381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35082656C
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: