Healthcare Provider Details

I. General information

NPI: 1417978107
Provider Name (Legal Business Name): ALISON R HEFFERNAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 MONTGOMERY RD SUITE 100
CINCINNATI OH
45242-3255
US

IV. Provider business mailing address

10700 MONTGOMERY RD SUITE 100
CINCINNATI OH
45242-3255
US

V. Phone/Fax

Practice location:
  • Phone: 513-984-5552
  • Fax: 513-984-5552
Mailing address:
  • Phone: 513-984-5552
  • Fax: 513-984-5552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number43664
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD.026395
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.093625
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: