MEDICARE: SUSAN L FREMONT MD

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	207Q00000X	Family Medicine Physician	35073721	OH

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	:	1386626893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN L FREMONT MD

Provider Business Mailing Address
First Line	:	4700 SMITH RD
Second Line	:	SUITE A
City	:	CINCINNATI
State	:	OH
Zip	:	45212-2787
Country	:	US
Telephone Number	:	513-533-1199
Fax Number	:	513-533-6000

Provider Business Practice Location Address
First Line	:	10675A LOVELAND MADEIRA RD
Second Line	:
City	:	LOVELAND
State	:	OH
Zip	:	45140-8965
Country	:	US
Telephone Number	:	513-774-8220
Fax Number	:	513-774-8229

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

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	02/03/2014

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Directions to “ SUSAN L FREMONT MD” Practice Location

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