Healthcare Provider Details

I. General information

NPI: 1891729158
Provider Name (Legal Business Name): ALAN J ANNENBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 12/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4030 SMITH RD SUITE 300
CINCINNATI OH
45209-1957
US

IV. Provider business mailing address

4030 SMITH RD SUITE 300
CINCINNATI OH
45209-1957
US

V. Phone/Fax

Practice location:
  • Phone: 513-421-3494
  • Fax: 513-345-2606
Mailing address:
  • Phone: 513-421-3494
  • Fax: 513-345-2606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35049257A
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25980
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number35049257A
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number25980
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: