Provider Demographics
NPI:1841582293
Name:HILDEBRANT, JASON THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:THOMAS
Last Name:HILDEBRANT
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 1:234 GOODMAN ST
Mailing Address - Street 2:HOSPITALIST ML670
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2364
Mailing Address - Country:US
Mailing Address - Phone:513-584-7545
Mailing Address - Fax:513-584-0851
Practice Address - Street 1:234 GOODMAN ST
Practice Address - Street 2:HOSPITALIST ML670
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2364
Practice Address - Country:US
Practice Address - Phone:513-584-7545
Practice Address - Fax:513-584-0851
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35123549207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0103632Medicaid
OHH316170Medicare PIN