Provider Demographics
NPI:1851393730
Name:PRAGALOS, ANTOINETTE A (MD)
Entity Type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:A
Last Name:PRAGALOS
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 1:4460 RED BANK RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45227-2173
Mailing Address - Country:US
Mailing Address - Phone:513-564-3870
Mailing Address - Fax:513-564-3871
Practice Address - Street 1:4460 RED BANK RD STE 100
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45227-2173
Practice Address - Country:US
Practice Address - Phone:513-564-3870
Practice Address - Fax:513-564-3871
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-06-7070207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0249412Medicaid
P00685499OtherRAIL ROAD MEDICARE
000000565730OtherANTHEM PIN
G47752Medicare UPIN
OHPR0813525Medicare PIN