Provider Demographics
NPI:1679672158
Name:UNIVERSITY OF CINCINNATI
Entity Type:Organization
Organization Name:UNIVERSITY OF CINCINNATI
Other - Org Name:UNIVE OF CINCINNATI DEPT
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHAIR
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:W
Authorized Official - Last Name:ROUAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-558-4231
Mailing Address - Street 1:3125 EDEN AVENUE
Mailing Address - Street 2:ML 0562
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45267-0562
Mailing Address - Country:US
Mailing Address - Phone:513-245-3430
Mailing Address - Fax:513-245-3449
Practice Address - Street 1:3125 EDEN AVE. ML 0508
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45267-0508
Practice Address - Country:US
Practice Address - Phone:513-558-2184
Practice Address - Fax:513-558-2203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-04-6787207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9300011Medicare PIN