Healthcare Provider Details

I. General information

NPI: 1710265350
Provider Name (Legal Business Name): SONAL BHALLA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2011
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4805 MONTGOMERY RD STE 210
CINCINNATI OH
45212-2280
US

IV. Provider business mailing address

4805 MONTGOMERY RD STE 150
CINCINNATI OH
45212-2280
US

V. Phone/Fax

Practice location:
  • Phone: 513-241-2370
  • Fax:
Mailing address:
  • Phone: 513-241-2370
  • Fax: 513-241-6053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.133026
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number35.133026
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number35.133026
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: