Provider Demographics
NPI:1164735569
Name:AGNEW, KAREN (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:AGNEW
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 1:9600 CHILDREN DR
Mailing Address - Street 2:BLDG D, SUITE 100
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-6791
Mailing Address - Country:US
Mailing Address - Phone:513-336-6700
Mailing Address - Fax:
Practice Address - Street 1:9600 CHILDREN DR
Practice Address - Street 2:BLDG D, SUITE 100
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-6791
Practice Address - Country:US
Practice Address - Phone:513-336-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.120553208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0090016Medicaid