Provider Demographics
NPI:1700828449
Name:CREEVY, JOSEPH A (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:A
Last Name:CREEVY
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 1:4700 SMITH RD
Mailing Address - Street 2:SUITE L
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-2787
Mailing Address - Country:US
Mailing Address - Phone:513-366-4000
Mailing Address - Fax:513-366-4001
Practice Address - Street 1:4700 SMITH RD
Practice Address - Street 2:SUITE L
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45212-2787
Practice Address - Country:US
Practice Address - Phone:513-366-4000
Practice Address - Fax:513-366-4001
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-03-1750208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY340011125OtherRAILROAD MEDICARE
OHP00013184OtherRAILROAD MEDICARE
OH0276946Medicaid
KY64186463Medicaid
OH0385908Medicaid
KY0362701Medicare PIN
KY64186463Medicaid
KY1114950001Medicare NSC
OH1114950001Medicare NSC
OH0385908Medicaid