Healthcare Provider Details

I. General information

NPI: 1447230065
Provider Name (Legal Business Name): GEETA SRIVASTAVA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 05/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 DIXMYTH AVENUE
CINCINNATI OH
45220-2475
US

IV. Provider business mailing address

PO BOX 636799
CINCINNATI OH
45263-1395
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 Number35-072089
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number41496
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number35-072089
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: