Healthcare Provider Details

I. General information

NPI: 1699140525
Provider Name (Legal Business Name): DEBORAH A. FRITZ, M.D. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2015
Last Update Date: 12/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10550 MONTGOMERY RD STE 23
CINCINNATI OH
45242-4422
US

IV. Provider business mailing address

10550 MONTGOMERY RD STE 23
CINCINNATI OH
45242-4422
US

V. Phone/Fax

Practice location:
  • Phone: 513-984-3313
  • Fax: 513-984-4698
Mailing address:
  • Phone: 513-984-3313
  • Fax: 513-984-4698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number35049127
License Number StateOH

VIII. Authorized Official

Name: DR. DEBORAH ANNE FRITZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 513-984-3313