1871206011 NPI number — GRAHAM TAYLOR GINGRAS DO

Table of content: GRAHAM TAYLOR GINGRAS DO (NPI 1871206011)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871206011 NPI number — GRAHAM TAYLOR GINGRAS DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GINGRAS
Provider First Name:
GRAHAM
Provider Middle Name:
TAYLOR
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1871206011
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/10/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
260 STETSON STREET, STE 3200, ML 0559 PO BOX 670559
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:
45267-0559
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-558-5100
Provider Business Mailing Address Fax Number:
513-558-5055

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
234 GOODMAN STREET
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:
45219-0769
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-558-5100
Provider Business Practice Location Address Fax Number:
513-558-5190
Provider Enumeration Date:
01/03/2023

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: "Y" .

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





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