Provider Demographics
NPI:1962578849
Name:BIBB, MARY H (MD)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:H
Last Name:BIBB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2567 ERIE AVE
Mailing Address - Street 2:2ND FL
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45208
Mailing Address - Country:US
Mailing Address - Phone:513-321-8500
Mailing Address - Fax:513-321-9888
Practice Address - Street 1:2567 ERIE AVE
Practice Address - Street 2:2ND FL
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45208
Practice Address - Country:US
Practice Address - Phone:513-321-8500
Practice Address - Fax:513-321-9888
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH350421052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
BI0451772Medicare ID - Type Unspecified
F24022Medicare UPIN