Healthcare Provider Details

I. General information

NPI: 1356329478
Provider Name (Legal Business Name): MARGUERITE M BLYTHE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 05/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4903 VINE ST
CINCINNATI OH
45217-1252
US

IV. Provider business mailing address

4903 VINE ST
CINCINNATI OH
45217-1252
US

V. Phone/Fax

Practice location:
  • Phone: 513-421-2900
  • Fax: 513-345-3045
Mailing address:
  • Phone: 513-421-2900
  • Fax: 513-345-3045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number35052570
License Number StateOH

VIII. Authorized Official

Name: MARGUERITE MARYANNA BLYTHE
Title or Position: MD OWNER
Credential: MD
Phone: 513-421-2900