Provider Demographics
NPI:1457328791
Name:BABCOCK, JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:BABCOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2830 VICTORY PKWY
Mailing Address - Street 2:STE. 320
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-1785
Mailing Address - Country:US
Mailing Address - Phone:513-245-3335
Mailing Address - Fax:513-475-7259
Practice Address - Street 1:222 PIEDMONT AVE
Practice Address - Street 2:STE. 7000
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-4231
Practice Address - Country:US
Practice Address - Phone:513-475-8787
Practice Address - Fax:513-475-7348
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35-033822208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0187819Medicaid
KY64096423Medicaid
IN20-0066500Medicaid
OH0187819Medicaid
OHBA0378917Medicare ID - Type Unspecified