Healthcare Provider Details

I. General information

NPI: 1013594746
Provider Name (Legal Business Name): JEREMY SAULD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2021
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4777 E GALBRAITH RD
CINCINNATI OH
45236-2725
US

IV. Provider business mailing address

4777 E GALBRAITH RD
CINCINNATI OH
45236-2725
US

V. Phone/Fax

Practice location:
  • Phone: 513-686-6868
  • Fax: 513-686-6868
Mailing address:
  • Phone: 513-686-6868
  • Fax: 513-686-6868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0102208902
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: