1871687145 NPI number — JOSEPH EDWARD THORPE MD

Table of content: SHAWNA RAE DONNER (NPI 1427609890)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871687145 NPI number — JOSEPH EDWARD THORPE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THORPE
Provider First Name:
JOSEPH
Provider Middle Name:
EDWARD
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:
1871687145
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10496 MONTGOMERY ROAD
Provider Second Line Business Mailing Address:
#103
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45242-5520
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-793-2654
Provider Business Mailing Address Fax Number:
513-793-2962

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10496 MONTGOMERY ROAD
Provider Second Line Business Practice Location Address:
SUITE #103
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45242-5520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-793-2654
Provider Business Practice Location Address Fax Number:
513-793-2962
Provider Enumeration Date:
10/03/2006

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: 207RC0200X , with the licence number:  35042513 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: 35042513 , 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: 0004216070 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000009373 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 290003405 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0620466 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4820114 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4251301 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".




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