Healthcare Provider Details

I. General information

NPI: 1366407355
Provider Name (Legal Business Name): RITA WINTON HERITAGE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 07/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5250 FAR HILLS AVE
KETTERING OH
45429-2382
US

IV. Provider business mailing address

25 MERCHANT STREET SUITE 220
CINCINNATI OH
45246-3740
US

V. Phone/Fax

Practice location:
  • Phone: 937-433-7991
  • Fax: 937-312-8116
Mailing address:
  • Phone: 513-533-6507
  • Fax: 513-645-9767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35050785
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2285521
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: