Provider Demographics
NPI:1891712634
Name:LEMBERG, BRADLEY MAURICE (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:MAURICE
Last Name:LEMBERG
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 1:752 WAYCROSS RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45240-3184
Mailing Address - Country:US
Mailing Address - Phone:513-825-5454
Mailing Address - Fax:513-825-5454
Practice Address - Street 1:752 WAYCROSS RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45240-3184
Practice Address - Country:US
Practice Address - Phone:513-825-5454
Practice Address - Fax:513-825-5454
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35031830207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0168956Medicaid
OH0168956Medicaid
OHLE0151215Medicare ID - Type UnspecifiedMEDICARE