Healthcare Provider Details

I. General information

NPI: 1497100051
Provider Name (Legal Business Name): ERIN WILSON REQUARTH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2016
Last Update Date: 10/01/2020
Certification Date: 10/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2123 AUBURN AVE STE 724
CINCINNATI OH
45219-2906
US

IV. Provider business mailing address

2123 AUBURN AVE STE 724
CINCINNATI OH
45219-2906
US

V. Phone/Fax

Practice location:
  • Phone: 513-241-4774
  • Fax: 513-204-3321
Mailing address:
  • Phone: 513-241-4774
  • Fax: 513-204-3321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35.139638
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: