Provider Demographics
NPI:1073665121
Name:PEDIATRICS OF HAMILTON INC
Entity Type:Organization
Organization Name:PEDIATRICS OF HAMILTON INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BLANKENBURG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-829-0800
Mailing Address - Street 1:1251 NILES ROAD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014
Mailing Address - Country:US
Mailing Address - Phone:513-829-0800
Mailing Address - Fax:513-829-8428
Practice Address - Street 1:1251 NILES ROAD
Practice Address - Street 2:SUITE 8
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014
Practice Address - Country:US
Practice Address - Phone:513-829-0800
Practice Address - Fax:513-829-8428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35051614B208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH05880636Medicaid