Healthcare Provider Details

I. General information

NPI: 1528033206
Provider Name (Legal Business Name): LOUIS R ROEDERSHEIMER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: L RICHARD ROEDERSHEIMER M.D.

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 02/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 MERCY HEALTH BLVD SECOND FLOOR, SUITE 2010
CINCINNATI OH
45211-1103
US

IV. Provider business mailing address

3300 MERCY HEALTH BLVD SECOND FLOOR, SUITE 2010
CINCINNATI OH
45211-1103
US

V. Phone/Fax

Practice location:
  • Phone: 513-961-4335
  • Fax: 513-961-4227
Mailing address:
  • Phone: 513-961-4335
  • Fax: 513-961-4227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35044670
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number35044670
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: