Healthcare Provider Details

I. General information

NPI: 1023283900
Provider Name (Legal Business Name): KATRINA PEARISO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2008
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3113 BELLEVUE AVE FL 3
CINCINNATI OH
45219-3158
US

IV. Provider business mailing address

3113 BELLEVUE AVE FL 3
CINCINNATI OH
45219-3158
US

V. Phone/Fax

Practice location:
  • Phone: 513-475-8730
  • Fax: 513-475-8033
Mailing address:
  • Phone: 513-475-8730
  • Fax: 513-475-8033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.098094
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number35.098094
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: