Healthcare Provider Details

I. General information

NPI: 1437124906
Provider Name (Legal Business Name): THERESA YOST SEWELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: THERESA MARIE YOST MD

II. Dates (important events)

Enumeration Date: 02/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4370 MALSBARY RD SUITE 100
CINCINNATI OH
45242-5653
US

IV. Provider business mailing address

4370 MALSBARY RD SUITE 100
CINCINNATI OH
45242-5653
US

V. Phone/Fax

Practice location:
  • Phone: 513-791-1222
  • Fax: 513-791-2561
Mailing address:
  • Phone: 513-791-1222
  • Fax: 513-791-2561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35080966
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: