Basic Information
| Provider Information | |||||||||
| NPI: | 1679672158 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNIVERSITY OF CINCINNATI | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | UNIVE OF CINCINNATI DEPT | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3125 EDEN AVENUE | ||||||||
| Address2: | ML 0562 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452670562 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132453430 | ||||||||
| FaxNumber: | 5132453449 | ||||||||
| Practice Location | |||||||||
| Address1: | 3125 EDEN AVE. ML 0508 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452670508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135582184 | ||||||||
| FaxNumber: | 5135582203 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2006 | ||||||||
| LastUpdateDate: | 12/14/2016 | ||||||||
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| AuthorizedOfficialLastName: | ROUAN | ||||||||
| AuthorizedOfficialFirstName: | GREGORY | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | CHAIR | ||||||||
| AuthorizedOfficialTelephone: | 5135584231 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0000X | 35-04-6787 | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology |
No ID Information.