Organization
LEBANON MEDICAL CENTER, INC
Active
Other names
Lebanon Medical Center, Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MADHUMATHI KOSARAJU M.D. (PRESIDENT)
(513) 228-1666
Entity
Organization
Contact information
Practice address
990 BELVEDERE DR STE A, LEBANON, OH 45036-2890
(513) 228-1666
(513) 228-1555
Mailing address
7661 BROOKFARM CT, MASON, OH 45040-7027
(513) 398-7376
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
207R00000X
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2545857
—
OH
01
—
378156491001
MEDICAL MUTUAL OF OHIO
OH
01
—
378156495-00
OHIO BWC
OH
01
—
P00219908
RAILROAD MEDICARE
OH
Enumeration date
11/20/2005
Last updated
05/12/2012
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