Healthcare Provider Details

I. General information

NPI: 1902884455
Provider Name (Legal Business Name): NILESH B JOBALIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 01/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3145 HAMILTON MASON RD SUITE 201
HAMILTON OH
45011-8557
US

IV. Provider business mailing address

PO BOX 127
HAMILTON OH
45012-0001
US

V. Phone/Fax

Practice location:
  • Phone: 513-454-2277
  • Fax: 513-454-2288
Mailing address:
  • Phone: 513-454-2277
  • Fax: 513-454-2288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35-062727
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number35-062727
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: