Provider Demographics
NPI:1265476071
Name:DUMBAULD, STEVEN L (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:L
Last Name:DUMBAULD
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 1:3219 CLIFTON AVE
Mailing Address - Street 2:#325
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45220-3027
Mailing Address - Country:US
Mailing Address - Phone:513-861-0800
Mailing Address - Fax:513-861-5111
Practice Address - Street 1:3219 CLIFTON AVE
Practice Address - Street 2:#325
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45220-3027
Practice Address - Country:US
Practice Address - Phone:513-861-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-039494207RN0300X
KY22388207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200070130Medicaid
OH990013023OtherMEDICARE RAILROAD
KY64782287Medicaid
OH0336943Medicaid
OH0514802Medicare PIN
OHA80384Medicare UPIN
IN200070130Medicaid