Provider Demographics
NPI:1760480107
Name:PILLOW, DEBORAH RAE (MD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:RAE
Last Name:PILLOW
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 1:16 E MAIN ST
Mailing Address - Street 2:STE 100
Mailing Address - City:ADDYSTON
Mailing Address - State:OH
Mailing Address - Zip Code:45001-2519
Mailing Address - Country:US
Mailing Address - Phone:513-941-8300
Mailing Address - Fax:513-941-8340
Practice Address - Street 1:16 E MAIN ST
Practice Address - Street 2:STE 100
Practice Address - City:ADDYSTON
Practice Address - State:OH
Practice Address - Zip Code:45001-2519
Practice Address - Country:US
Practice Address - Phone:513-941-8300
Practice Address - Fax:513-941-8340
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57335207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0779895Medicaid
OH0779895Medicaid