Provider Demographics
NPI:1285675207
Name:SUNTAY, ALFREDO S (MD)
Entity Type:Individual
Prefix:
First Name:ALFREDO
Middle Name:S
Last Name:SUNTAY
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 1:2415 AUBURN AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2701
Mailing Address - Country:US
Mailing Address - Phone:513-221-4949
Mailing Address - Fax:513-221-4954
Practice Address - Street 1:2415 AUBURN AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2701
Practice Address - Country:US
Practice Address - Phone:513-221-4949
Practice Address - Fax:513-221-4954
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35035258207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0242624Medicaid
OH2034541Medicare PIN
OH0242624Medicaid
OH2034543Medicare PIN
OH2034542Medicare PIN