Provider Demographics
NPI:1841394301
Name:TOBIAS, JONATHAN (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:TOBIAS
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 1:2830 VICTORY PKWY
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-1785
Mailing Address - Country:US
Mailing Address - Phone:513-245-3617
Mailing Address - Fax:513-475-7259
Practice Address - Street 1:234 GOODMAN ST
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2364
Practice Address - Country:US
Practice Address - Phone:513-558-4500
Practice Address - Fax:513-558-2289
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35078310207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2685876Medicaid
OHP00390340OtherMEDICARE RAILROAD
OH000000491488OtherANTHEM
IN200842530Medicaid
KY7100007410Medicaid
OH7134865OtherAETNA
IN200842530Medicaid