Healthcare Provider Details

I. General information

NPI: 1497734180
Provider Name (Legal Business Name): CONSTANCE A. WURZBACHER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 11/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10475 READING RD SUITE 307
CINCINNATI OH
45241-2563
US

IV. Provider business mailing address

4685 FOREST AVE
CINCINNATI OH
45212-3397
US

V. Phone/Fax

Practice location:
  • Phone: 513-563-2030
  • Fax: 513-563-1682
Mailing address:
  • Phone: 513-853-4721
  • Fax: 513-852-8525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35083720
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: