Healthcare Provider Details

I. General information

NPI: 1255481412
Provider Name (Legal Business Name): PEDIATRIC ASSOCIATES OF MONTGOMERY LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10600 MONTGOMERY ROAD SUITE 300
CINCINNATI OH
45242
US

IV. Provider business mailing address

10600 MONTGOMERY ROAD SUITE 300
CINCINNATI OH
45242
US

V. Phone/Fax

Practice location:
  • Phone: 513-984-2510
  • Fax: 513-984-1015
Mailing address:
  • Phone: 513-984-2510
  • Fax: 513-984-1015

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. RONALD KENT IRVIN
Title or Position: MEMBER
Credential:
Phone: 513-984-2510