Basic Information
| Provider Information | |||||||||
| NPI: | 1053334755 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RETZINGER | ||||||||
| FirstName: | GREGORY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2830 VICTORY PKWY | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452061785 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132453617 | ||||||||
| FaxNumber: | 5134757259 | ||||||||
| Practice Location | |||||||||
| Address1: | 231 ALBERT SABIN WAY | ||||||||
| Address2: | DEPARTMENT OF PATHOLOGY | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452670001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135584500 | ||||||||
| FaxNumber: | 5135582289 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2006 | ||||||||
| LastUpdateDate: | 01/27/2010 | ||||||||
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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 | 207ZP0105X | 35-06-4628-R | OH | Y | Allopathic & Osteopathic Physicians | Pathology | Clinical Pathology/Laboratory Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0919340 | 05 | OH | MEDICAID | 000000009068 | 01 | OH | ANTHEM | OTHER | 283990 | 01 | OH | AMERIGROUP | OTHER | 200000700A | 05 | IN | MEDICAID | 64937923 | 05 | KY | MEDICAID |