Provider Demographics
NPI:1295730380
Name:HEMMELGARN, LORI MARIE (MD)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:MARIE
Last Name:HEMMELGARN
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 1:11124 MARLETTE DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45249-2253
Mailing Address - Country:US
Mailing Address - Phone:937-271-6471
Mailing Address - Fax:
Practice Address - Street 1:11124 MARLETTE DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249-2253
Practice Address - Country:US
Practice Address - Phone:937-271-6471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35061006207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5095573OtherAETNA
OHANTHEMOther000000122981
OH311711751027OtherCARESOURCE
OH0701800OtherUNITED HEALTH CARE
OH2052371Medicaid
OHD61006OtherHUMAN/CHOICE CARE
OHANTHEMOther000000122981
OH311711751027OtherCARESOURCE
OH2052371Medicaid
OH0701800OtherUNITED HEALTH CARE