Provider Demographics
NPI:1619101979
Name:MAGNER, KRISTIN PATRICIA (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:PATRICIA
Last Name:MAGNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:PATRICIA
Other - Last Name:SHULL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:237 WILLIAM HOWARD TAFT RD
Mailing Address - Street 2:2ND FLOOR, CBO2-3, ATTN: CREDENTIALING
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2610
Mailing Address - Country:US
Mailing Address - Phone:513-263-8551
Mailing Address - Fax:513-366-4480
Practice Address - Street 1:2123 AUBURN AVE
Practice Address - Street 2:SUITE 624
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2906
Practice Address - Country:US
Practice Address - Phone:513-564-4000
Practice Address - Fax:513-564-4001
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-14
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.120206207V00000X
KY46211207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0088619Medicaid
KY7100259300Medicaid
OHH222770OtherMEDICARE