Provider Demographics
NPI:1578563284
Name:MT. AUBURN NEPHROLOGY, INC.
Entity Type:Organization
Organization Name:MT. AUBURN NEPHROLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAHZAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SAFDAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-841-0222
Mailing Address - Street 1:8251 PINE ROAD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236
Mailing Address - Country:US
Mailing Address - Phone:513-841-0222
Mailing Address - Fax:513-841-0638
Practice Address - Street 1:8251 PINE ROAD
Practice Address - Street 2:SUITE 212
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236
Practice Address - Country:US
Practice Address - Phone:513-841-0222
Practice Address - Fax:513-841-0638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-22
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35044778207RN0300X
207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0908012Medicaid