MEDICARE: DR. GEOFFREY ALAN PORNOY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	35426	KY
2	207P00000X	Emergency Medicine Physician	01041308A	IN
3	207P00000X	Emergency Medicine Physician	35.062762	OH
4	207R00000X	Internal Medicine Physician	35426	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235108317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEOFFREY ALAN PORNOY M.D.

Provider Business Mailing Address
First Line	:	PO BOX 635283
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-5283
Country	:	US
Telephone Number	:	859-344-5555
Fax Number	:	859-344-5552

Provider Business Practice Location Address
First Line	:	2626 ALEXANDRIA PIKE
Second Line	:
City	:	HIGHLAND HEIGHTS
State	:	KY
Zip	:	41076-1530
Country	:	US
Telephone Number	:	859-757-0434
Fax Number	:	859-441-0906

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	04/07/2021

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Directions to “ DR. GEOFFREY ALAN PORNOY M.D.” Practice Location

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