Healthcare Provider Details

I. General information

NPI: 1013193911
Provider Name (Legal Business Name): PEDIATRIC ASSOCIATES OF MT. CARMEL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2008
Last Update Date: 01/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4371 FERGUSON DR
CINCINNATI OH
45245-1668
US

IV. Provider business mailing address

4371 FERGUSON DR
CINCINNATI OH
45245-1668
US

V. Phone/Fax

Practice location:
  • Phone: 513-752-3650
  • Fax:
Mailing address:
  • Phone: 513-752-3650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL CHAMBERLIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 513-752-3650