Healthcare Provider Details

I. General information

NPI: 1699297002
Provider Name (Legal Business Name): SAMANTHA LYNN MCGRAW CST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 GOODMAN ST
CINCINNATI OH
45219-2364
US

IV. Provider business mailing address

234 GOODMAN STREET ML 0731
CINCINNATI OH
45219-2364
US

V. Phone/Fax

Practice location:
  • Phone: 513-584-8853
  • Fax: 513-584-5022
Mailing address:
  • Phone: 513-584-8853
  • Fax: 513-584-5022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number172857
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: