Provider Demographics
NPI:1528033206
Name:ROEDERSHEIMER, LOUIS R (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:R
Last Name:ROEDERSHEIMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:L
Other - Middle Name:RICHARD
Other - Last Name:ROEDERSHEIMER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3300 MERCY HEALTH BLVD
Mailing Address - Street 2:SECOND FLOOR, SUITE 2010
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-1103
Mailing Address - Country:US
Mailing Address - Phone:513-961-4335
Mailing Address - Fax:513-961-4227
Practice Address - Street 1:3300 MERCY HEALTH BLVD
Practice Address - Street 2:SECOND FLOOR, SUITE 2010
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-1103
Practice Address - Country:US
Practice Address - Phone:513-961-4335
Practice Address - Fax:513-961-4227
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2014-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35044670208600000X, 2086S0129X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0432919Medicaid
OH0432919Medicaid
OHA84022Medicare UPIN
OH0432919Medicaid
IN200001370Medicaid
OH0482241Medicare PIN
OH0482246OtherMEDICARE
KY7100056850Medicaid
OH770000253OtherRR MEDICARE
KY1459505Medicare ID - Type UnspecifiedKENTUCKY MEDICARE
KY1459505Medicare PIN
791480709Medicare PIN
KYP00689759Medicare PIN
791480709OtherRAILROAD MEDICARE
OH791480709OtherRR MEDICARE
KYP00689759OtherRR MEDICARE KY
OHA84022Medicare UPIN