Healthcare Provider Details

I. General information

NPI: 1326142829
Provider Name (Legal Business Name): TARI S ANDERSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 12/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5777 KELLOGG AVENUE
CINCINNATI OH
45230
US

IV. Provider business mailing address

5777 KELLOGG AVE
CINCINNATI OH
45230-7142
US

V. Phone/Fax

Practice location:
  • Phone: 513-232-3232
  • Fax: 513-232-3202
Mailing address:
  • Phone: 513-232-3232
  • Fax: 513-232-3202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number35058827
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: