Provider Demographics
NPI:1619950656
Name:EBEL, ROSE (DO)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:EBEL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1470 N BROADWAY ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-1762
Mailing Address - Country:US
Mailing Address - Phone:513-932-1936
Mailing Address - Fax:513-932-3105
Practice Address - Street 1:1470 N BROADWAY ST STE 100
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036
Practice Address - Country:US
Practice Address - Phone:513-932-1936
Practice Address - Fax:513-932-3105
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006337S207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2288224Medicaid
OH2288224Medicaid
OHH53350Medicare UPIN