Provider Demographics
NPI:1932157435
Name:NUGENT, PAUL J (DO)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:J
Last Name:NUGENT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4440 RED BANK RD STE 110
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45227-2177
Mailing Address - Country:US
Mailing Address - Phone:513-564-1366
Mailing Address - Fax:513-564-1367
Practice Address - Street 1:4440 RED BANK RD STE 110
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45227-2177
Practice Address - Country:US
Practice Address - Phone:513-564-1366
Practice Address - Fax:513-564-1367
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34004621207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0933575Medicaid
NU0821626Medicare PIN
OH0933575Medicaid
NU0821626Medicare PIN
OH0933575Medicaid