Provider Demographics
NPI:1770506347
Name:WARE, AVIS ELLEN (MD)
Entity Type:Individual
Prefix:
First Name:AVIS
Middle Name:ELLEN
Last Name:WARE
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:STE 310
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-3700
Mailing Address - Country:US
Mailing Address - Phone:513-245-3444
Mailing Address - Fax:513-245-3449
Practice Address - Street 1:3130 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2333
Practice Address - Country:US
Practice Address - Phone:513-584-4061
Practice Address - Fax:513-584-2599
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.065332207RR0500X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2027078Medicaid
G46038Medicare UPIN
OHWA0819821Medicare PIN
OHWA0819824Medicare PIN