Basic Information
| Provider Information | |||||||||
| NPI: | 1043213028 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BILOTTA | ||||||||
| FirstName: | VINCENT | ||||||||
| MiddleName: | THOMAS | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2060 READING RD | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452021454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593412510 | ||||||||
| FaxNumber: | 8595782004 | ||||||||
| Practice Location | |||||||||
| Address1: | 20 MEDICAL VILLAGE DRIVE | ||||||||
| Address2: | SUITE 302 | ||||||||
| City: | EDGEWOOD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410175402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593412510 | ||||||||
| FaxNumber: | 8595782004 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2005 | ||||||||
| LastUpdateDate: | 07/29/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 27838 | KY | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 35. 059153 | OH | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 64278385 | 05 | KY | MEDICAID |