Provider Demographics
NPI:1457354235
Name:LORSBACH, ROBERT B (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:B
Last Name:LORSBACH
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:PO BOX 636256 CENTRAL CREDENTIALING
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6256
Mailing Address - Country:US
Mailing Address - Phone:513-585-5507
Mailing Address - Fax:513-585-5511
Practice Address - Street 1:3333 BURNET AVE
Practice Address - Street 2:ML 1010
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3026
Practice Address - Country:US
Practice Address - Phone:513-636-4261
Practice Address - Fax:513-636-3026
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE4998207ZH0000X
TN31249207ZH0000X
OH35.124563207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200377080AMedicaid
MO205094105Medicaid
MS00120394Medicaid
MT0149549Medicaid
OK100200820AMedicaid
AR136341001Medicaid
AZ542870Medicaid
NC7613558Medicaid
NJ0030961Medicaid
TN3838303Medicaid
ARP00370752OtherRAILROAD MEDICARE
AL009914400Medicaid
IA0527689Medicaid
LA1429732Medicaid
IN200224770AMedicaid
KY64721988Medicaid
MI104783064Medicaid
ME422400000Medicaid
GA536148329AMedicaid
AR136341001Medicaid
GA536148329AMedicaid