Provider Demographics
NPI:1649512138
Name:OXNER, KATHLEEN J (MD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:J
Last Name:OXNER
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:J
Other - Last Name:DONNELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 PRESTIGE PL STE 550
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-6115
Mailing Address - Country:US
Mailing Address - Phone:937-762-1310
Mailing Address - Fax:937-522-8068
Practice Address - Street 1:3535 PENTAGON BLVD STE 400
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-1705
Practice Address - Country:US
Practice Address - Phone:937-490-2264
Practice Address - Fax:937-490-2266
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-22
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.128463207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0175628Medicaid