Provider Demographics
NPI:1811974058
Name:JAZY, FOROOGH K (MD)
Entity type:Individual
Prefix:DR
First Name:FOROOGH
Middle Name:K
Last Name:JAZY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:FOROOGH
Other - Middle Name:K
Other - Last Name:JAZY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:8450 BLUECUT LN
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45243-1162
Mailing Address - Country:US
Mailing Address - Phone:513-820-2414
Mailing Address - Fax:513-984-0622
Practice Address - Street 1:3020 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:OH
Practice Address - Zip Code:45103-1962
Practice Address - Country:US
Practice Address - Phone:513-984-6786
Practice Address - Fax:513-984-0622
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35. 0355602085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0287694Medicaid
OHA81878Medicare UPIN
OH0563434Medicare PIN