1740234558 NPI number — MARY E COON MD

Table of content: (NPI 1275224149)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740234558 NPI number — MARY E COON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COON
Provider First Name:
MARY
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740234558
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4750 HEMPSTEAD STATION DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KETTERING
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45429-5164
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-875-0136
Provider Business Mailing Address Fax Number:
937-619-4381

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2950 ROBERTSON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45209-1268
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-281-4400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/19/2006

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: 207P00000X , with the licence number:  35082656C , 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: 000000316949 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00294036 . This is a "RR MEDICARE FAIRFIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2448051 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000386935 . This is a "BCBS FAIRFIELD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: P00096090 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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