Healthcare Provider Details

I. General information

NPI: 1932664695
Provider Name (Legal Business Name): THE PEDIATRICIANS OF HYDE PARK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2019
Last Update Date: 09/07/2021
Certification Date: 09/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3666 PAXTON AVE
CINCINNATI OH
45208-1568
US

IV. Provider business mailing address

3666 PAXTON AVE
CINCINNATI OH
45208-1568
US

V. Phone/Fax

Practice location:
  • Phone: 513-871-0684
  • Fax: 513-871-0705
Mailing address:
  • Phone: 513-871-0684
  • Fax: 513-871-0705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. EDWARD R GARVIN
Title or Position: PHYSCIAN
Credential: MD
Phone: 513-871-0684