Provider Demographics
NPI:1730135625
Name:BILLMIRE, MARY ELAINE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELAINE
Last Name:BILLMIRE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4600 WESLEY AVE
Mailing Address - Street 2:STE. N
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-2298
Mailing Address - Country:US
Mailing Address - Phone:513-246-7796
Mailing Address - Fax:513-246-7855
Practice Address - Street 1:9070 WINTON RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-3828
Practice Address - Country:US
Practice Address - Phone:513-246-7000
Practice Address - Fax:513-728-4344
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35038413208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0396290Medicaid
OHE33488Medicare UPIN
OHBI4206301Medicare PIN