Provider Demographics
NPI:1548586704
Name:RICCI, KIERSTEN WALTHER (MD)
Entity Type:Individual
Prefix:
First Name:KIERSTEN
Middle Name:WALTHER
Last Name:RICCI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KIERSTEN
Other - Middle Name:JUSTINA
Other - Last Name:WALTHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3333 BURNET AVE
Mailing Address - Street 2:ML 7015
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3039
Mailing Address - Country:US
Mailing Address - Phone:513-636-4266
Mailing Address - Fax:513-636-1025
Practice Address - Street 1:3333 BURNET AVE
Practice Address - Street 2:ML 7015
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3039
Practice Address - Country:US
Practice Address - Phone:513-636-4266
Practice Address - Fax:513-636-1025
Is Sole Proprietor?:No
Enumeration Date:2010-04-13
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.1219392080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology