1053424143 NPI number — AUSTIN WAND MD

Table of content: AUSTIN WAND MD (NPI 1053424143)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053424143 NPI number — AUSTIN WAND MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WAND
Provider First Name:
AUSTIN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1053424143
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2600 EUCLID AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45219-2102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-618-2848
Provider Business Mailing Address Fax Number:
513-618-2849

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
234 GOODMAN ST
Provider Second Line Business Practice Location Address:
DEPARTMENT OF RADIOLOGY
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45267-1000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-584-2146
Provider Business Practice Location Address Fax Number:
513-584-0431
Provider Enumeration Date:
08/16/2006

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: 2085R0202X , with the licence number:  35078200 , 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: 000000077822 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2184541 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2328522 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 64014285 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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