Healthcare Provider Details

I. General information

NPI: 1982903951
Provider Name (Legal Business Name): CG MEDICAL ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2011
Last Update Date: 12/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 BEECHMONT AVE
CINCINNATI OH
45230-4119
US

IV. Provider business mailing address

7300 BEECHMONT AVE
CINCINNATI OH
45230-4119
US

V. Phone/Fax

Practice location:
  • Phone: 513-232-9100
  • Fax: 513-232-3333
Mailing address:
  • Phone: 513-232-9100
  • Fax: 513-232-3333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number35094424
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35094424
License Number StateOH

VIII. Authorized Official

Name: CHETAN GUPTA
Title or Position: CEO
Credential: MD
Phone: 513-232-9100