Provider Demographics
NPI:1710928288
Name:MANDERS, ERNEST CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:CHARLES
Last Name:MANDERS
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 1:237 WILLIAM HOWARD TAFT, PHYS DIV
Mailing Address - Street 2:2ND FL, CBO2-3, ATTN: CREDENTIALING
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2906
Mailing Address - Country:US
Mailing Address - Phone:513-263-8571
Mailing Address - Fax:513-366-4480
Practice Address - Street 1:2123 AUBURN AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2906
Practice Address - Country:US
Practice Address - Phone:513-421-5558
Practice Address - Fax:513-632-5804
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2020-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35081478207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP01239193OtherRAIDROAD MEDICARE
OHP01239193OtherMEDICAID
OH792946OtherANTHEM
OH270577733080OtherCARESOURCE
OH7791443OtherAETNA
IN201211320OtherMEDICAID
OHH164360OtherMEDICARE