Basic Information
Provider Information
NPI: 1699448365
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ADHIA
FirstName: DHARTI
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: LGC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3333 BURNET AVE., ML 9016
Address2:  
City: CINCNNATI
State: OH
PostalCode: 452293026
CountryCode: US
TelephoneNumber: 5136364408
FaxNumber: 5136367337
Practice Location
Address1: 3333 BURNET AVE # MLC9016
Address2:  
City: CINCINNATI
State: OH
PostalCode: 452293026
CountryCode: US
TelephoneNumber: 5136364408
FaxNumber: 5136367337
Other Information
ProviderEnumerationDate: 07/28/2021
LastUpdateDate: 08/30/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/30/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
170300000X  Y Other Service ProvidersGenetic Counselor, MS 

No ID Information.


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