Healthcare Provider Details

I. General information

NPI: 1144255282
Provider Name (Legal Business Name): PATRICK G. O'DANIEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 08/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 DIXMYTH AVE
CINCINNATI OH
45220-2475
US

IV. Provider business mailing address

375 DIXMYTH AVE
CINCINNATI OH
45220-2475
US

V. Phone/Fax

Practice location:
  • Phone: 513-862-3452
  • Fax: 513-862-3421
Mailing address:
  • Phone: 513-862-3452
  • Fax: 513-862-3421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number26547
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number35127554
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: