1619903374 NPI number — DR. HAROLD G. KELSO PH.D.

Table of content: DR. HAROLD G. KELSO PH.D. (NPI 1619903374)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619903374 NPI number — DR. HAROLD G. KELSO PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KELSO
Provider First Name:
HAROLD
Provider Middle Name:
G.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
M

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:
1619903374
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
260 STETSON STREET
Provider Second Line Business Mailing Address:
ML 0530 SUITE 5200
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45267-0530
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-558-2919
Provider Business Mailing Address Fax Number:
513-558-4458

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
222 PIEDMONT AVE
Provider Second Line Business Practice Location Address:
SUITE 3400
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45219-4231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-475-7718
Provider Business Practice Location Address Fax Number:
513-475-7711
Provider Enumeration Date:
06/24/2006

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: 103T00000X , with the licence number:  3910 , 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: 000000012171 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 89540157 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0168107 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200510310 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com