Basic Information
Provider Information
NPI: 1710111380
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CARRACHER
FirstName: COLIN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 636256
Address2: CENTRAL CREDENTIALING
City: CINCINNATI
State: OH
PostalCode: 452636256
CountryCode: US
TelephoneNumber: 5135855507
FaxNumber: 5135855511
Practice Location
Address1: 222 PIEDMONT AVE
Address2:  
City: CINCINNATI
State: OH
PostalCode: 452194231
CountryCode: US
TelephoneNumber: 5134757400
FaxNumber: 5134758201
Other Information
ProviderEnumerationDate: 05/11/2009
LastUpdateDate: 07/11/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RE0101X35.099126OHY Allopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism

No ID Information.


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