1275535163 NPI number — SUE A KARNITIS MD

Table of content: SUE A KARNITIS MD (NPI 1275535163)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275535163 NPI number — SUE A KARNITIS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KARNITIS
Provider First Name:
SUE
Provider Middle Name:
A
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:
1275535163
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/10/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
825 N MAIN STREET
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
SPRINGBORO
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45066-1503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-762-5500
Provider Business Mailing Address Fax Number:
937-762-5099

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
825 N MAIN STREET
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
SPRINGBORO
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45066-1503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-762-5500
Provider Business Practice Location Address Fax Number:
937-762-5099
Provider Enumeration Date:
08/11/2005

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: 208000000X , with the licence number:  35062496 , 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: 000000141221 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 01930 . This is a "PARAMOUNT" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0637763 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0863927 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 370012700 . This is a "RRMC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 12-01219 . This is a "UHC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: KO790972 . This is a "MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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