Healthcare Provider Details

I. General information

NPI: 1437104098
Provider Name (Legal Business Name): QUEEN CITY EAR NOSE AND THROAT ASSOC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 01/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11135 MONTGOMERY RD
CINCINNATI OH
45249-2338
US

IV. Provider business mailing address

PO BOX 706187
CINCINNATI OH
45270-0001
US

V. Phone/Fax

Practice location:
  • Phone: 513-793-9600
  • Fax: 513-793-4928
Mailing address:
  • Phone: 513-793-9600
  • Fax: 513-793-4928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK DAVID DEUTSCH
Title or Position: PRESIDENT
Credential: MD
Phone: 513-793-9600