1922073485 NPI number — DR. CAROL L EGNER MD

Table of content: DR. CAROL L EGNER MD (NPI 1922073485)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922073485 NPI number — DR. CAROL L EGNER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EGNER
Provider First Name:
CAROL
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
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:
1922073485
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/25/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4685 FOREST AVE
Provider Second Line Business Mailing Address:
STE C
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45212-3359
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-662-8222
Provider Business Mailing Address Fax Number:
513-662-8002

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6480 HARRISON AVE
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45247-7961
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-662-8222
Provider Business Practice Location Address Fax Number:
513-662-8002
Provider Enumeration Date:
02/20/2006

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: 207VX0000X , with the licence number:  35049746 , 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: 110021648 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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