Healthcare Provider Details

I. General information

NPI: 1134689680
Provider Name (Legal Business Name): TAYLOR RYAN CARREL-LAMMERT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 09/09/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE, ML 2008
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

2227 DREX AVE
CINCINNATI OH
45212-1603
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-7966
  • Fax: 513-636-7967
Mailing address:
  • Phone: 910-622-3803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.145393
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: