Provider Demographics
NPI:1952441891
Name:KUBALA, GINGER S (MD)
Entity Type:Individual
Prefix:
First Name:GINGER
Middle Name:S
Last Name:KUBALA
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 1:10550 MONTGOMERY RD
Mailing Address - Street 2:# 12
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4494
Mailing Address - Country:US
Mailing Address - Phone:513-791-1201
Mailing Address - Fax:513-791-1231
Practice Address - Street 1:10550 MONTGOMERY RD
Practice Address - Street 2:# 12
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-4494
Practice Address - Country:US
Practice Address - Phone:513-791-1201
Practice Address - Fax:513-791-1231
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35057045207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0829616Medicaid
OHG09767Medicare UPIN
OH0829616Medicaid