Provider Demographics
NPI:1114967973
Name:BUFFINGTON, PHILIP J (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:J
Last Name:BUFFINGTON
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 1:2000 JOSEPH E SANKER BLVD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-1979
Mailing Address - Country:US
Mailing Address - Phone:513-841-7400
Mailing Address - Fax:513-841-7402
Practice Address - Street 1:4360 FERGUSON DR STE 100
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-1683
Practice Address - Country:US
Practice Address - Phone:513-841-7750
Practice Address - Fax:513-841-7751
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-2155208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH340011131OtherRAILROAD MEDICARE
OH0824406Medicaid
KY64955206Medicaid
OH1114950018Medicare NSC
OH0690466Medicare PIN
KY64955206Medicaid
OH0690464Medicare PIN
E78895Medicare UPIN