Basic Information
| Provider Information | |||||||||
| NPI: | 1215563218 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | ABRAHAM | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 260 STETSON STREET, SUITE 3200 | ||||||||
| Address2: | PO BOX 670559 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452670559 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135585190 | ||||||||
| FaxNumber: | 5135583477 | ||||||||
| Practice Location | |||||||||
| Address1: | 260 STETSON STREET | ||||||||
| Address2: | SUITE 3200 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452670559 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135585190 | ||||||||
| FaxNumber: | 5135583477 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2020 | ||||||||
| LastUpdateDate: | 09/09/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.