Healthcare Provider Details

I. General information

NPI: 1104186584
Provider Name (Legal Business Name): ANNA JOLANTA IPSARO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA JOLANTA IPSARO M.D.

II. Dates (important events)

Enumeration Date: 05/21/2012
Last Update Date: 06/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE ML 9016
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

3333 BURNET AVE ML 9016
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-803-8092
  • Fax: 513-803-9245
Mailing address:
  • Phone: 513-803-8092
  • Fax: 513-803-9245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.122491
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: