Provider Demographics
NPI:1679781629
Name:PEARCE, ANJALI D (MD)
Entity Type:Individual
Prefix:
First Name:ANJALI
Middle Name:D
Last Name:PEARCE
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 1:2830 VICTORY PKWY
Mailing Address - Street 2:CREDENTIALING
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-1785
Mailing Address - Country:US
Mailing Address - Phone:513-245-3431
Mailing Address - Fax:513-475-7259
Practice Address - Street 1:3130 HIGHLAND AVE
Practice Address - Street 2:MED-PEDES CLINIC
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2399
Practice Address - Country:US
Practice Address - Phone:513-584-4061
Practice Address - Fax:513-584-3349
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57010368207R00000X
OH35-094034207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2952112Medicaid
OH2952112Medicaid