Healthcare Provider Details

I. General information

NPI: 1083653380
Provider Name (Legal Business Name): ROBERT B CUCINOTTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 05/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 CEREAL AVE SUITE 209
HAMILTON OH
45013-2784
US

IV. Provider business mailing address

1010 CEREAL AVE SUITE 209
HAMILTON OH
45013-2784
US

V. Phone/Fax

Practice location:
  • Phone: 513-867-2834
  • Fax: 513-867-2873
Mailing address:
  • Phone: 513-867-2834
  • Fax: 513-867-2873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number35-05-4838
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: