Healthcare Provider Details

I. General information

NPI: 1700170495
Provider Name (Legal Business Name): AMANDA C BAINBRIDGE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA C HODGES PA

II. Dates (important events)

Enumeration Date: 05/31/2011
Last Update Date: 12/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 ALBERT SABIN WAY ML 0769
CINCINNATI OH
45267-2827
US

IV. Provider business mailing address

3200 BURNET AVE 3 SOUTH, CREDENTIALING
CINCINNATI OH
45229-3019
US

V. Phone/Fax

Practice location:
  • Phone: 513-558-5281
  • Fax: 513-558-5791
Mailing address:
  • Phone: 513-558-5281
  • Fax: 513-558-5791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.003279
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: