Healthcare Provider Details

I. General information

NPI: 1083087316
Provider Name (Legal Business Name): MEDPACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2015
Last Update Date: 11/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5375 MEDPACE WAY
CINCINNATI OH
45227-1543
US

IV. Provider business mailing address

5375 MEDPACE WAY
CINCINNATI OH
45227-1543
US

V. Phone/Fax

Practice location:
  • Phone: 513-579-9911
  • Fax: 513-579-0444
Mailing address:
  • Phone: 513-579-9911
  • Fax: 513-579-0444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number35.062348
License Number StateOH

VIII. Authorized Official

Name: DR. JONATHAN LESTER ISAACSOHN
Title or Position: CHIEF MEDICAL OFFICER
Credential: M.D.
Phone: 513-579-9911