Provider Demographics
NPI:1356311484
Name:DUARTE, OLGA (MD)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:DUARTE
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 1:8000 5 MILE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45230-2163
Mailing Address - Country:US
Mailing Address - Phone:513-231-1671
Mailing Address - Fax:513-231-1642
Practice Address - Street 1:8000 5 MILE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-2163
Practice Address - Country:US
Practice Address - Phone:513-231-1671
Practice Address - Fax:513-231-1642
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35055672207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2337251Medicaid
OHE32951Medicare UPIN
OH2337251Medicaid