Provider Demographics
NPI:1871556266
Name:RIVERA, JOANN O (MD)
Entity type:Individual
Prefix:
First Name:JOANN
Middle Name:O
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:9313 S MASON MONTGOMERY RD
Mailing Address - Street 2:STE. 200
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-8081
Mailing Address - Country:US
Mailing Address - Phone:513-584-6999
Mailing Address - Fax:513-584-6998
Practice Address - Street 1:9313 MASON MONTGOMERY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040
Practice Address - Country:US
Practice Address - Phone:513-584-6999
Practice Address - Fax:513-584-6998
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2012-09-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35074550R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2068444Medicaid
G80027Medicare UPIN
OH2068444Medicaid
OH110172983Medicare PIN