Healthcare Provider Details

I. General information

NPI: 1457146243
Provider Name (Legal Business Name): TIMOTHY IGNATIUS MAYNARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2025
Last Update Date: 04/11/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3177 BELLEVUE AVENUE
CINCINNATI OH
45219-0796
US

IV. Provider business mailing address

DEPARTMENT OF ANESTHESIOLOGY 231 ALBERT SABIN WAY, ML 0531
CINCINNATI OH
45267-0531
US

V. Phone/Fax

Practice location:
  • Phone: 513-558-6356
  • Fax: 513-558-0995
Mailing address:
  • Phone: 513-558-6356
  • Fax: 513-558-0995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: