Provider Demographics
NPI:1174033864
Name:MCNULTY, AIDAN J
Entity Type:Individual
Prefix:
First Name:AIDAN
Middle Name:J
Last Name:MCNULTY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10296 SPRINGFIELD PIKE STE 500
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215-1194
Mailing Address - Country:US
Mailing Address - Phone:513-942-4555
Mailing Address - Fax:513-346-2747
Practice Address - Street 1:10296 SPRINGFIELD PIKE STE 500
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45215-1194
Practice Address - Country:US
Practice Address - Phone:513-942-4555
Practice Address - Fax:513-346-2747
Is Sole Proprietor?:No
Enumeration Date:2017-10-06
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2910854171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator