Healthcare Provider Details

I. General information

NPI: 1528024338
Provider Name (Legal Business Name): KATHERYN ELLEN KERMODE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERYN ELLEN JADEED MD

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 03/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

379 DIXMYTH AVE
CINCINNATI OH
45220
US

IV. Provider business mailing address

4685 FOREST AVE
CINCINNATI OH
45212-3397
US

V. Phone/Fax

Practice location:
  • Phone: 513-246-7000
  • Fax: 513-246-7590
Mailing address:
  • Phone: 513-246-7000
  • Fax: 513-246-7590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35-086940
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35-086940
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: