Healthcare Provider Details

I. General information

NPI: 1407801962
Provider Name (Legal Business Name): CAROL A FORSSELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVENUE ML 4002
CINCINNATI OH
45229
US

IV. Provider business mailing address

3333 BURNET AVENUE ML 5021
CINCINNATI OH
45229
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4688
  • Fax: 513-636-7361
Mailing address:
  • Phone: 513-636-5013
  • Fax: 866-213-7084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number35083164
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: