Healthcare Provider Details

I. General information

NPI: 1477783207
Provider Name (Legal Business Name): PRIYANKA VASHISHT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2009
Last Update Date: 02/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 GOODMAN ST IMMUNOLOGY/ALLERGY/RHEUMATOLOGY
CINCINNATI OH
45219-2364
US

IV. Provider business mailing address

PO BOX 636256 CENTRAL CREDENTIALING
CINCINNATI OH
45263-6256
US

V. Phone/Fax

Practice location:
  • Phone: 513-558-5513
  • Fax: 513-458-1984
Mailing address:
  • Phone: 513-558-5504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number6072
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number35 127912
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: