Provider Demographics
NPI:1023289857
Name:DESIDERIO PINA, MD, MPH, INC
Entity type:Organization
Organization Name:DESIDERIO PINA, MD, MPH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DESIDERIO
Authorized Official - Middle Name:
Authorized Official - Last Name:PINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-748-2035
Mailing Address - Street 1:84 REMICK BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-9168
Mailing Address - Country:US
Mailing Address - Phone:937-748-2035
Mailing Address - Fax:937-748-2035
Practice Address - Street 1:84 REMICK BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066-9168
Practice Address - Country:US
Practice Address - Phone:937-748-2035
Practice Address - Fax:937-748-2035
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DESIDERIO PINA, MD, MPH, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350835732084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2447598Medicaid
OHH97888Medicare UPIN
OHPI14122035Medicare PIN