Provider Demographics
NPI:1144222407
Name:DAVITT, SEAN P (MD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:P
Last Name:DAVITT
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:PO BOX 631662
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-1662
Mailing Address - Country:US
Mailing Address - Phone:859-581-7120
Mailing Address - Fax:859-581-7207
Practice Address - Street 1:1577B GOODMAN AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45224-1004
Practice Address - Country:US
Practice Address - Phone:513-729-1321
Practice Address - Fax:513-729-2873
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.081594207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200414730Medicaid
KY7100007110Medicaid
OH2363044Medicaid
180046022OtherMEDICARE RAILROAD
OH4093895Medicare PIN
OHH71797Medicare UPIN
OH2363044Medicaid
OH4093891Medicare PIN
OH4093893Medicare PIN