Provider Demographics
NPI:1871574780
Name:MAGENHEIM, DOUGLAS A (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:A
Last Name:MAGENHEIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9050 MONTGOMERY RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-7740
Mailing Address - Country:US
Mailing Address - Phone:513-631-6963
Mailing Address - Fax:513-631-1970
Practice Address - Street 1:9050 MONTGOMERY ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-7712
Practice Address - Country:US
Practice Address - Phone:513-631-6963
Practice Address - Fax:513-631-1970
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35058585M207R00000X
OH35058585207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0824764Medicaid
E82870Medicare UPIN
08091419Medicare PIN
OH0824764Medicaid