Provider Demographics
NPI:1356799456
Name:OH, SANDERS (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:SANDERS
Middle Name:
Last Name:OH
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 E FREEDOM WAY UNIT 326
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-3480
Mailing Address - Country:US
Mailing Address - Phone:312-351-0696
Mailing Address - Fax:
Practice Address - Street 1:8000 5 MILE RD STE 100
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-2187
Practice Address - Country:US
Practice Address - Phone:513-233-6980
Practice Address - Fax:513-233-6983
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-31
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332545207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty