Healthcare Provider Details

I. General information

NPI: 1730649385
Provider Name (Legal Business Name): DESIREE DIBELLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVENUE ML 6015
CINCINNATI OH
45229-4315
US

IV. Provider business mailing address

3333 BURNET AVENUE ML 6015
CINCINNATI OH
45229-4315
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-0800
  • Fax: 513-803-0823
Mailing address:
  • Phone: 513-636-0800
  • Fax: 513-803-0823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.149227
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: