Provider Demographics
NPI:1073686085
Name:SMALL, JONATHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:SMALL
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 1:8050 HOSBROOK RD
Mailing Address - Street 2:SUITE 402
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-2994
Mailing Address - Country:US
Mailing Address - Phone:513-794-0083
Mailing Address - Fax:513-794-0083
Practice Address - Street 1:8050 HOSBROOK RD
Practice Address - Street 2:SUITE 402
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-2907
Practice Address - Country:US
Practice Address - Phone:513-794-0083
Practice Address - Fax:513-794-0083
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0431752084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHD31374Medicare UPIN
OHP00067248Medicare ID - Type UnspecifiedRAILROAD MEDICARE