Healthcare Provider Details

I. General information

NPI: 1306253018
Provider Name (Legal Business Name): NAT NASOMYONT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2014
Last Update Date: 01/06/2021
Certification Date: 01/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE ML 7012
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

3333 BURNET AVE ML 7012
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4744
  • Fax: 513-636-7486
Mailing address:
  • Phone: 513-636-4744
  • Fax: 513-636-7486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number131441
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.131441
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number35.131441
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: