Provider Demographics
NPI:1104868694
Name:MT. AIRY MEDICAL ARTS, INC.
Entity type:Organization
Organization Name:MT. AIRY MEDICAL ARTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUDMILA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:GRACANIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-923-3500
Mailing Address - Street 1:2841 BLUE ROCK RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45239-6334
Mailing Address - Country:US
Mailing Address - Phone:513-923-3500
Mailing Address - Fax:513-923-4464
Practice Address - Street 1:2841 BLUE ROCK RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45239-6334
Practice Address - Country:US
Practice Address - Phone:513-923-3500
Practice Address - Fax:513-923-4464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F70991Medicare UPIN
OHGR0752361Medicare ID - Type Unspecified