Healthcare Provider Details

I. General information

NPI: 1104084482
Provider Name (Legal Business Name): PEDIATRIC ASSOCIATES OF CINCINNATI, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2008
Last Update Date: 05/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4370 MALSBARY RD SUITE 100
CINCINNATI OH
45242-5653
US

IV. Provider business mailing address

4370 MALSBARY RD SUITE 100
CINCINNATI OH
45242-5653
US

V. Phone/Fax

Practice location:
  • Phone: 513-791-1222
  • Fax: 513-791-2561
Mailing address:
  • Phone: 513-791-1222
  • Fax: 513-791-2561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SANDY NARDINI
Title or Position: OFFICE MANAGER
Credential:
Phone: 513-791-2532