Healthcare Provider Details

I. General information

NPI: 1023273687
Provider Name (Legal Business Name): AJIT GUBBI D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2008
Last Update Date: 04/22/2021
Certification Date: 04/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 IVY GTWY STE 1100
CINCINNATI OH
45245-1898
US

IV. Provider business mailing address

5053 WOOSTER RD
CINCINNATI OH
45226-2326
US

V. Phone/Fax

Practice location:
  • Phone: 513-751-2273
  • Fax: 513-751-1840
Mailing address:
  • Phone: 513-751-2273
  • Fax: 513-751-1848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number248054
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number5101022136
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number34.010162
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: