Provider Demographics
NPI:1649245325
Name:SOBOLEWSKI, ANNA P (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:P
Last Name:SOBOLEWSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3747 W FORK RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247-7548
Mailing Address - Country:US
Mailing Address - Phone:513-961-4335
Mailing Address - Fax:513-961-4227
Practice Address - Street 1:3747 W FORK RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45247-7548
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:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35074319208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH020039337OtherRAILROAD MEDICARE
IN200177410AMedicaid
IN200177410Medicaid
KY64959984Medicaid
OH2066544Medicaid
KY7100056850Medicaid
O20039337Medicare PIN
KY1459515Medicare PIN
KY7100056850Medicaid
IN200177410AMedicaid
OH020039337OtherRAILROAD MEDICARE