Provider Demographics
NPI:1710924139
Name:COTTONGIM, TONI LESLIE (MD)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:LESLIE
Last Name:COTTONGIM
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:PO BOX 637676
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-0001
Mailing Address - Country:US
Mailing Address - Phone:513-481-0900
Mailing Address - Fax:513-481-0904
Practice Address - Street 1:6350 GLENWAY AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-6378
Practice Address - Country:US
Practice Address - Phone:513-481-0900
Practice Address - Fax:513-481-0904
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35072447207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2055369Medicaid
OHP00458766Medicare PIN
OH0821206Medicare PIN
OH0821208Medicare PIN
OHCO0821207Medicare PIN
OHCO0821201Medicare ID - Type Unspecified
OH2055369Medicaid