Provider Demographics
NPI:1417903469
Name:SIFRI, EDMOND G (MD)
Entity Type:Individual
Prefix:DR
First Name:EDMOND
Middle Name:G
Last Name:SIFRI
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 1:4692 MISSION LN
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45223-1263
Mailing Address - Country:US
Mailing Address - Phone:513-541-9051
Mailing Address - Fax:
Practice Address - Street 1:5914 GLENWAY AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-2009
Practice Address - Country:US
Practice Address - Phone:513-922-4271
Practice Address - Fax:513-922-3936
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350311922080P0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0121862Medicaid