Provider Demographics
NPI:1447230065
Name:SRIVASTAVA, GEETA (MD)
Entity Type:Individual
Prefix:
First Name:GEETA
Middle Name:
Last Name:SRIVASTAVA
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 636799
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-1395
Mailing Address - Country:US
Mailing Address - Phone:513-862-3452
Mailing Address - Fax:513-862-3421
Practice Address - Street 1:375 DIXMYTH AVENUE
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:513-862-3452
Practice Address - Fax:513-862-3421
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2017-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-072089207R00000X, 208M00000X
KY41496207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2342469Medicaid
KY7100018530Medicaid
KY0018200Medicare PIN
OH4099584Medicare PIN
KY03403809Medicare PIN
KY7100018530Medicaid
KY3403414Medicare PIN
OH2342469Medicaid
OH4099585Medicare PIN
KY0969465Medicare PIN