Healthcare Provider Details

I. General information

NPI: 1043203896
Provider Name (Legal Business Name): SANDRA E DICKENS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 12/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 DIXMYTH AVE
CINCINNATI OH
45220-2475
US

IV. Provider business mailing address

PO BOX 631395
CINCINNATI OH
45263-1395
US

V. Phone/Fax

Practice location:
  • Phone: 513-872-3452
  • Fax: 513-872-3421
Mailing address:
  • Phone: 513-569-6386
  • Fax: 513-569-6320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number35-067906
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: