Provider Demographics
NPI:1992839179
Name:OREJUELA, AUSBERTO ALFONSO (MD)
Entity Type:Individual
Prefix:
First Name:AUSBERTO
Middle Name:ALFONSO
Last Name:OREJUELA
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 1:5590 NIGHTENGALE COURT
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45227
Mailing Address - Country:US
Mailing Address - Phone:513-272-1398
Mailing Address - Fax:
Practice Address - Street 1:7017 VINE ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45216-2031
Practice Address - Country:US
Practice Address - Phone:513-821-2201
Practice Address - Fax:513-821-2202
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0227776Medicaid
OH0227776Medicaid
0373061Medicare ID - Type Unspecified