Healthcare Provider Details
I. General information
NPI: 1891181772
Provider Name (Legal Business Name): JULIA CAMILLE BEDARD-THOMAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 04/08/2015
Last Update Date: 08/01/2022
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:
III. Provider practice location address
3805 EDWARDS RD STE 350
CINCINNATI OH
45209-1940
US
IV. Provider business mailing address
3805 EDWARDS RD STE 350
CINCINNATI OH
45209-1940
US
V. Phone/Fax
- Phone: 513-871-7848
- Fax: 513-871-3278
- Phone: 513-871-7848
- Fax: 513-871-3278
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2084P0800X |
| Taxonomy | Psychiatry Physician |
| License Number | 35-133012 |
| License Number State | OH |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207Q00000X |
| Taxonomy | Family Medicine Physician |
| License Number | 35.133012 |
| License Number State | OH |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: