MEDICARE: DR. MAHBOOB NOORY 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	207Q00000X	Family Medicine Physician	35061251	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
2	42799948	OTHER	OH	AETNA
3	61251	OTHER	OH	CHOICE CARE

General Provider Information

NPI Number	:	1528061595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAHBOOB NOORY M.D.

Provider Business Mailing Address
First Line	:	PO BOX 635156
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-5156
Country	:	US
Telephone Number	:	513-683-3020
Fax Number	:	513-677-4585

Provider Business Practice Location Address
First Line	:	411 W LOVELAND AVE
Second Line	:	STE 102
City	:	LOVELAND
State	:	OH
Zip	:	45140-2358
Country	:	US
Telephone Number	:	513-683-3020
Fax Number	:	513-677-4585

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	06/07/2010

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