Provider Demographics
NPI: | 1396867974 |
---|---|
Name: | VON HOENE, AMANDA MARIE (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | AMANDA |
Middle Name: | MARIE |
Last Name: | VON HOENE |
Suffix: | |
Gender: | F |
Credentials: | MD |
Other - Prefix: | DR |
Other - First Name: | AMANDA |
Other - Middle Name: | MARIE |
Other - Last Name: | BRESSLER |
Other - Suffix: | |
Other - Last Name Type: | Former Name |
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: | 859-912-6500 |
Mailing Address - Fax: | 859-442-1501 |
Practice Address - Street 1: | 375 DIXMYTH AVE |
Practice Address - Street 2: | |
Practice Address - City: | CINCINNATI |
Practice Address - State: | OH |
Practice Address - Zip Code: | 45220-2475 |
Practice Address - Country: | US |
Practice Address - Phone: | 513-246-7000 |
Practice Address - Fax: | 513-246-7463 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2007-04-04 |
Last Update Date: | 2020-09-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OH | 57.015714 | 207V00000X |
KY | 45435 | 207V00000X |
OH | 35.140397 | 207V00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
KY | 7100205710 | Medicaid | |
OH | 0066793 | Medicaid | |
OH | 2565399 | Medicaid | |
KY | P01112162 | Other | RR MEDICARE |