Healthcare Provider Details

I. General information

NPI: 1184691230
Provider Name (Legal Business Name): JENNIFER BRYNA KATZ MANDERS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 10/29/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 RED BANK ROAD SUITE 200
CINCINNATI OH
45227-2172
US

IV. Provider business mailing address

237 WILLIAM HOWARD TAFT, PHYS. DIV. 2ND FL, CBO2-3, ATTN: CREDENTIALING
CINCINNATI OH
45219-2906
US

V. Phone/Fax

Practice location:
  • Phone: 513-564-5000
  • Fax: 513-564-4925
Mailing address:
  • Phone: 513-263-8571
  • Fax: 513-263-8622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number35-086334
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: