Basic Information
| Provider Information | |||||||||
| NPI: | 1447230065 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SRIVASTAVA | ||||||||
| FirstName: | GEETA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 636799 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452631395 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138623452 | ||||||||
| FaxNumber: | 5138623421 | ||||||||
| Practice Location | |||||||||
| Address1: | 375 DIXMYTH AVENUE | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452202475 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138623452 | ||||||||
| FaxNumber: | 5138623421 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2006 | ||||||||
| LastUpdateDate: | 05/29/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 35-072089 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207V00000X | 41496 | KY | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 208M00000X | 35-072089 | OH | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 2342469 | 05 | OH | MEDICAID | 7100018530 | 05 | KY | MEDICAID |