Provider Demographics
NPI:1669475133
Name:RADEMACHER, JAMES R (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:RADEMACHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4445 LAKE FOREST DR STE 600
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-3744
Mailing Address - Country:US
Mailing Address - Phone:513-515-6172
Mailing Address - Fax:937-335-6684
Practice Address - Street 1:180 S STANFIELD RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-0106
Practice Address - Country:US
Practice Address - Phone:937-335-9020
Practice Address - Fax:937-335-6684
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26886207W00000X
OH35089288207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC20036127OtherSELECT HEALTH
SC9624212OtherGHI
SC7439590OtherAETNA
SC268864Medicaid
SCP00127042OtherRAILROAD MEDICARE
SCP00127042OtherRAILROAD MEDICARE
SC20036127OtherSELECT HEALTH
SC9624212OtherGHI