Healthcare Provider Details

I. General information

NPI: 1891926226
Provider Name (Legal Business Name): BRADLEY M. LEMBERG MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2009
Last Update Date: 08/18/2009
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: 513-825-5452
Mailing address:
  • Phone: 513-825-5454
  • Fax: 513-825-5452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number35031830
License Number StateOH

VIII. Authorized Official

Name: DR. BRADLEY M. LEMBERG
Title or Position: OWNER
Credential: MD
Phone: 513-825-5454