1649512138 NPI number — KATHLEEN J OXNER M.D.

Table of content: KATHLEEN J OXNER M.D. (NPI 1649512138)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649512138 NPI number — KATHLEEN J OXNER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OXNER
Provider First Name:
KATHLEEN
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DONNELLY
Provider Other First Name:
KATHLEEN
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1649512138
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/31/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 PRESTIGE PL STE 550
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMISBURG
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45342-6115
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-762-1310
Provider Business Mailing Address Fax Number:
937-522-8068

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3535 PENTAGON BLVD STE 400
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEAVERCREEK
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45431-1705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-490-2264
Provider Business Practice Location Address Fax Number:
937-490-2266
Provider Enumeration Date:
03/22/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 35.128463 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0175628 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".