Provider Demographics
NPI:1053334755
Name:RETZINGER, GREGORY (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:RETZINGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2830 VICTORY PKWY
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-1785
Mailing Address - Country:US
Mailing Address - Phone:513-245-3617
Mailing Address - Fax:513-475-7259
Practice Address - Street 1:231 ALBERT SABIN WAY
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45267-0001
Practice Address - Country:US
Practice Address - Phone:513-558-4500
Practice Address - Fax:513-558-2289
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-06-4628-R207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0919340Medicaid
OH000000009068OtherANTHEM
OH283990OtherAMERIGROUP
IN200000700AMedicaid
KY64937923Medicaid
OH283990OtherAMERIGROUP
OHF08983Medicare UPIN