Provider Demographics
NPI:1902888100
Name:PUTERBAUGH, DOUGLAS E (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:E
Last Name:PUTERBAUGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 SMITH RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-2787
Mailing Address - Country:US
Mailing Address - Phone:513-533-1199
Mailing Address - Fax:513-533-6000
Practice Address - Street 1:6825 WOOSTER PIKE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45227-4328
Practice Address - Country:US
Practice Address - Phone:513-272-0250
Practice Address - Fax:513-272-1728
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35048735P207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0553155Medicaid
28754380Medicare PIN
OHPU0540376Medicare PIN
OHP00915572Medicare PIN
OHA15565Medicare UPIN
OH0540375Medicare PIN
OH0553155Medicaid