Healthcare Provider Details

I. General information

NPI: 1366735599
Provider Name (Legal Business Name): CRISTINA DEANNE STEWART COLE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS CRISTINA DEANNE STEWART

II. Dates (important events)

Enumeration Date: 05/20/2011
Last Update Date: 06/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 DIXMYTH AVE
CINCINNATI OH
45220-2475
US

IV. Provider business mailing address

40 CARPENTERS RUN
BLUE ASH OH
45241-3248
US

V. Phone/Fax

Practice location:
  • Phone: 513-862-2261
  • Fax:
Mailing address:
  • Phone: 513-862-2261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number35.128302
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: