Provider Demographics
NPI:1437124906
Name:SEWELL, THERESA YOST (MD)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:YOST
Last Name:SEWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:THERESA
Other - Middle Name:MARIE
Other - Last Name:YOST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4370 MALSBARY RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-5653
Mailing Address - Country:US
Mailing Address - Phone:513-791-1222
Mailing Address - Fax:513-791-2561
Practice Address - Street 1:4370 MALSBARY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-5653
Practice Address - Country:US
Practice Address - Phone:513-791-1222
Practice Address - Fax:513-791-2561
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35080966208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2507746Medicaid