Provider Demographics
NPI:1588768006
Name:SEMERTZIDES, JOHN N (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:N
Last Name:SEMERTZIDES
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:PO BOX 635836
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-0001
Mailing Address - Country:US
Mailing Address - Phone:513-247-9201
Mailing Address - Fax:513-247-9420
Practice Address - Street 1:10495 MONTGOMERY RD
Practice Address - Street 2:STE. 21
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-4468
Practice Address - Country:US
Practice Address - Phone:513-247-9201
Practice Address - Fax:513-247-9420
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35052899208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64866866Medicaid
OH0617541Medicaid
OH0579653Medicare PIN
OH0617541Medicaid