Provider Demographics
NPI:1134137805
Name:DAVID, PACITA A (MD)
Entity Type:Individual
Prefix:DR
First Name:PACITA
Middle Name:A
Last Name:DAVID
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2052 PRINCETON ROAD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-4746
Mailing Address - Country:US
Mailing Address - Phone:513-863-6383
Mailing Address - Fax:513-863-3772
Practice Address - Street 1:375 DIXMYTH AVE
Practice Address - Street 2:10TH FL
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45220-2489
Practice Address - Country:US
Practice Address - Phone:513-862-7338
Practice Address - Fax:513-862-5139
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350715242084P0800X
OH35-07-1524-D261QM0850X, 320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2203896Medicaid
G50649Medicare UPIN
OHDA4087115Medicare ID - Type Unspecified