Provider Demographics
NPI:1245449438
Name:FIDELHOLTZ, JAMES I (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:I
Last Name:FIDELHOLTZ
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 1:6103 HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45224-2585
Mailing Address - Country:US
Mailing Address - Phone:513-681-6667
Mailing Address - Fax:513-681-0252
Practice Address - Street 1:6103 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45224-2585
Practice Address - Country:US
Practice Address - Phone:513-681-6667
Practice Address - Fax:513-681-0252
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.034849207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0373117Medicaid
OH0427062Medicare ID - Type UnspecifiedOHIO MEDICARE
OH0373117Medicaid