Provider Demographics
NPI:1295763845
Name:VIVIAN, RODNEY E (MD)
Entity type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:E
Last Name:VIVIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-301-5901
Mailing Address - Fax:859-301-5940
Practice Address - Street 1:4452 EASTGATE BLVD STE 202
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-1584
Practice Address - Country:US
Practice Address - Phone:513-232-3070
Practice Address - Fax:513-232-5794
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350415752084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000011245OtherANTHEM
OH0401827Medicaid
OH036793000OtherMAGELLAN
OH0401827Medicaid