Provider Demographics
NPI:1699303891
Name:OPSAHL, MADELEINE PINNE (DO)
Entity type:Individual
Prefix:DR
First Name:MADELEINE
Middle Name:PINNE
Last Name:OPSAHL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8920 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-7814
Mailing Address - Country:US
Mailing Address - Phone:913-636-9524
Mailing Address - Fax:
Practice Address - Street 1:240 ALBERT SABIN WAY BLDG R2ND
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-2842
Practice Address - Country:US
Practice Address - Phone:913-636-9524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-01
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022017921207ZP0102X
390200000X
OH34.016898207ZP0213X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0213XAllopathic & Osteopathic PhysiciansPathologyPediatric Pathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program