Healthcare Provider Details

I. General information

NPI: 1497378681
Provider Name (Legal Business Name): JAYATI PAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2020
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date: 01/18/2022
Reactivation Date: 09/07/2022

III. Provider practice location address

4627 AICHOLTZ RD
CINCINNATI OH
45244-1447
US

IV. Provider business mailing address

424 WARDS CORNER RD STE 200
LOVELAND OH
45140-6966
US

V. Phone/Fax

Practice location:
  • Phone: 513-753-2820
  • Fax:
Mailing address:
  • Phone: 513-707-4048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.156758
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: