Provider Demographics
NPI:1336350990
Name:DICHIARA, AMY J (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:J
Last Name:DICHIARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 739
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:KY
Mailing Address - Zip Code:41091-0739
Mailing Address - Country:US
Mailing Address - Phone:859-363-5515
Mailing Address - Fax:859-545-5074
Practice Address - Street 1:23 TAFT HWY STE B
Practice Address - Street 2:
Practice Address - City:DRY RIDGE
Practice Address - State:KY
Practice Address - Zip Code:41035-8121
Practice Address - Country:US
Practice Address - Phone:859-363-5515
Practice Address - Fax:859-545-5074
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY44216207RG0100X
OH35.094692207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100230830Medicaid
KY7100230830Medicaid