Provider Demographics
NPI:1821050741
Name:BOTSFORD, JOHN A (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:BOTSFORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7800 E KEMPER RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45249-1664
Mailing Address - Country:US
Mailing Address - Phone:513-530-9200
Mailing Address - Fax:513-530-0555
Practice Address - Street 1:600 WILSON CREEK RD
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:LAWRENCEBURG
Practice Address - State:IN
Practice Address - Zip Code:47025-2751
Practice Address - Country:US
Practice Address - Phone:812-537-8105
Practice Address - Fax:812-537-3240
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35044574B2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200072460Medicaid
KY64782097Medicaid
BO0524354OtherPTAN
OH0501906Medicaid
C02444Medicare UPIN
IN200072460Medicaid
KY172710CMedicare PIN
OH0501906Medicaid
IN172710CMedicare PIN