Provider Demographics
NPI:1073701843
Name:MAEDER, ELIZABETH B (DO)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:B
Last Name:MAEDER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2135 DANA AVE SUITE 210
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45207
Mailing Address - Country:US
Mailing Address - Phone:513-351-1200
Mailing Address - Fax:513-351-1580
Practice Address - Street 1:2135 DANA AVE SUITE 210
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45207
Practice Address - Country:US
Practice Address - Phone:513-351-1200
Practice Address - Fax:513-351-1580
Is Sole Proprietor?:No
Enumeration Date:2007-10-05
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.009091207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2984221Medicaid
OH2984221Medicaid
OH2984221Medicaid
OHMA4226442Medicare PIN