Provider Demographics
NPI:1427004852
Name:BASHOVER, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:BASHOVER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8175 BLOME RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45243-1311
Mailing Address - Country:US
Mailing Address - Phone:513-745-9682
Mailing Address - Fax:513-745-9682
Practice Address - Street 1:8175 BLOME RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45243-1311
Practice Address - Country:US
Practice Address - Phone:513-745-9682
Practice Address - Fax:513-745-9682
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.044866207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0491525Medicaid
OHA15093Medicare UPIN
OHP00340303Medicare PIN
OHBA4194491Medicare PIN