Healthcare Provider Details

I. General information

NPI: 1598709529
Provider Name (Legal Business Name): JONATHAN MUMMA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 02/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7810 5 MILE RD
CINCINNATI OH
45230-2356
US

IV. Provider business mailing address

4600 WESLEY AVE STE N
CINCINNATI OH
45212-2298
US

V. Phone/Fax

Practice location:
  • Phone: 513-232-1253
  • Fax: 513-232-4290
Mailing address:
  • Phone: 513-841-5520
  • Fax: 513-841-1580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35061860
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: