Healthcare Provider Details

I. General information

NPI: 1245358845
Provider Name (Legal Business Name): NORTHEAST CINCINNATI PEDIATRIC ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8185 CORPORATE WAY
MASON OH
45040-6809
US

IV. Provider business mailing address

8185 CORPORATE WAY
MASON OH
45040-6809
US

V. Phone/Fax

Practice location:
  • Phone: 513-398-7171
  • Fax:
Mailing address:
  • Phone: 513-398-7171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DENITA KAHERL
Title or Position: BILLING DEPARTMENT MANAGER
Credential:
Phone: 513-530-2090