Provider Demographics
NPI:1518994029
Name:SZUMLAS, GREGORY A (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:A
Last Name:SZUMLAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3430 BURNET AVE., MEDICAL OFFICE BLDG., 2ND FLOOR
Mailing Address - Street 2:ML 5026
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3026
Mailing Address - Country:US
Mailing Address - Phone:513-636-7722
Mailing Address - Fax:513-636-3737
Practice Address - Street 1:3430 BURNET AVE., MEDICAL OFFICE BLDG., 2ND FLOOR
Practice Address - Street 2:ML 5026
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3026
Practice Address - Country:US
Practice Address - Phone:513-636-7722
Practice Address - Fax:513-636-3737
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35067689208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0991959Medicaid
F93776Medicare UPIN
OH0991959Medicaid