Provider Demographics
NPI:1912946146
Name:RIVERA, EMMANUEL V (MD)
Entity Type:Individual
Prefix:DR
First Name:EMMANUEL
Middle Name:V
Last Name:RIVERA
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:PO BOX 23128
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45223-0128
Mailing Address - Country:US
Mailing Address - Phone:513-891-7574
Mailing Address - Fax:513-793-1032
Practice Address - Street 1:619 OAK ST
Practice Address - Street 2:STE 645
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45206-1613
Practice Address - Country:US
Practice Address - Phone:513-569-6780
Practice Address - Fax:513-569-6555
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-079874207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2292835Medicaid
KY64065543Medicaid
OH2292835Medicaid
OHH53339Medicare UPIN
OH4125491Medicare PIN