Provider Demographics
NPI:1376533372
Name:PFAFF, RHONDA R (MD)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:R
Last Name:PFAFF
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:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-212-4468
Mailing Address - Fax:859-212-4357
Practice Address - Street 1:1 MEDICAL VILLAGE DR
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-3403
Practice Address - Country:US
Practice Address - Phone:859-212-0003
Practice Address - Fax:859-344-5553
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32130174400000X, 207Q00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No174400000XOther Service ProvidersSpecialist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64040041Medicaid
OH2549371Medicaid
KY3313253Medicare PIN
OH2549371Medicaid
KYK024680Medicare PIN
KY3400156Medicare PIN
G76494Medicare UPIN
KY080188162Medicare PIN