Healthcare Provider Details

I. General information

NPI: 1386913960
Provider Name (Legal Business Name): MARIO SEFTON RIPORTELLA PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2011
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7575 5 MILE RD
CINCINNATI OH
45230-4346
US

IV. Provider business mailing address

7575 5 MILE RD
CINCINNATI OH
45230-4346
US

V. Phone/Fax

Practice location:
  • Phone: 513-232-6677
  • Fax: 513-232-2522
Mailing address:
  • Phone: 513-232-6677
  • Fax: 513-232-2522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.003455RX
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50.003455
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: