Provider Demographics
NPI:1841532348
Name:PETIT, DANIELLE (MD)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:PETIT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6770 CINCINNATI DAYTON RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45044-9319
Mailing Address - Country:US
Mailing Address - Phone:513-276-4981
Mailing Address - Fax:513-547-4671
Practice Address - Street 1:6770 CINCINNATI DAYTON RD STE 200
Practice Address - Street 2:
Practice Address - City:LIBERTY TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45044-9319
Practice Address - Country:US
Practice Address - Phone:513-579-9191
Practice Address - Fax:513-579-0350
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-22
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.129956207N00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0226310Medicaid