Healthcare Provider Details

I. General information

NPI: 1700880317
Provider Name (Legal Business Name): SAMUEL DEL MAURO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 08/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11111 MONTGOMERY RD
CINCINNATI OH
45249-2391
US

IV. Provider business mailing address

11111 MONTGOMERY RD
CINCINNATI OH
45249-2391
US

V. Phone/Fax

Practice location:
  • Phone: 513-605-4800
  • Fax: 513-605-4805
Mailing address:
  • Phone: 513-605-4800
  • Fax: 513-605-4805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number004305
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: