Provider Demographics
NPI:1518908250
Name:NIEHAUSER, GREGORY A (DO)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:A
Last Name:NIEHAUSER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6350 CHEVIOT RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247-5108
Mailing Address - Country:US
Mailing Address - Phone:513-981-4300
Mailing Address - Fax:513-741-1416
Practice Address - Street 1:6350 CHEVIOT RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45247-5108
Practice Address - Country:US
Practice Address - Phone:513-981-4300
Practice Address - Fax:513-741-1416
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34005312207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0993153Medicaid
OH0993153Medicaid
OHF48406Medicare UPIN