Healthcare Provider Details

I. General information

NPI: 1891712634
Provider Name (Legal Business Name): BRADLEY MAURICE LEMBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 04/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

752 WAYCROSS RD
CINCINNATI OH
45240-3184
US

IV. Provider business mailing address

752 WAYCROSS RD
CINCINNATI OH
45240-3184
US

V. Phone/Fax

Practice location:
  • Phone: 513-825-5454
  • Fax: 513-825-5454
Mailing address:
  • Phone: 513-825-5454
  • Fax: 513-825-5454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number35031830
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: