Healthcare Provider Details

I. General information

NPI: 1013130699
Provider Name (Legal Business Name): RICHARD J SANDERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 08/16/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3645 STONECREEK BLVD UNIT D
CINCINNATI OH
45251-1469
US

IV. Provider business mailing address

2415 AUBURN AVE
CINCINNATI OH
45219-2701
US

V. Phone/Fax

Practice location:
  • Phone: 513-923-2300
  • Fax:
Mailing address:
  • Phone: 513-221-4949
  • Fax: 513-241-4191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35051345
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: