Basic Information
| Provider Information | |||||||||
| NPI: | 1225084593 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOLSON | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | SCOTT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11140 MONTGOMERY RD | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452492309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132215500 | ||||||||
| FaxNumber: | 5132211962 | ||||||||
| Practice Location | |||||||||
| Address1: | 560 S LOOP RD | ||||||||
| Address2: | |||||||||
| City: | EDGEWOOD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410173405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593012663 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2006 | ||||||||
| LastUpdateDate: | 05/24/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 35060711 | OH | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 681017 | 01 | OH | ANTHEM | OTHER | 0729377 | 01 | OH | MEDICARE | OTHER | 273088817052 | 01 | OH | CARESOURCE | OTHER | K129140 | 01 | KY | MEDICARE | OTHER | 1225084593 | 01 | OH | MEDICAL MUTUAL | OTHER | 1929640 | 01 | OH | GATEWAY | OTHER | 4238799 | 01 | OH | AETNA | OTHER | 563852 | 01 | OH | WELLCARE | OTHER | 742492 / 676792 | 01 | OH | BUCKEYE MEDICAID / MEDICARE | OTHER | P00875698 | 01 | OH | RAILROAD MEDICARE | OTHER | 0892646 | 01 | OH | MEDICAID | OTHER |