Healthcare Provider Details

I. General information

NPI: 1639271828
Provider Name (Legal Business Name): LAWSON WULSIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 02/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 W GALBRAITH RD
CINCINNATI OH
45216-1015
US

IV. Provider business mailing address

3200 BURNET AVE 1 RIDGEWAY
CINCINNATI OH
45229-3019
US

V. Phone/Fax

Practice location:
  • Phone: 513-948-2639
  • Fax: 513-948-2516
Mailing address:
  • Phone: 513-585-9009
  • Fax: 513-585-9373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35053683
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: