1174552251 NPI number — BARTOLOMEO GIANNATTASIO MD

Table of content: BARTOLOMEO GIANNATTASIO MD (NPI 1174552251)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174552251 NPI number — BARTOLOMEO GIANNATTASIO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GIANNATTASIO
Provider First Name:
BARTOLOMEO
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174552251
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/22/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7255 OLD OAK BLVD
Provider Second Line Business Mailing Address:
C208
Provider Business Mailing Address City Name:
MIDDLEBURG HEIGHTS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44130-3329
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-816-2708
Provider Business Mailing Address Fax Number:
440-243-8480

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7255 OLD OAK BLVD
Provider Second Line Business Practice Location Address:
C208
Provider Business Practice Location Address City Name:
MIDDLEBURG HEIGHTS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44130-3329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-816-2708
Provider Business Practice Location Address Fax Number:
440-243-8480
Provider Enumeration Date:
07/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  35075324 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0001X , with the licence number: 35075324 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 341487428 . This is a "TAX ID" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2190392 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: P75324 . This is a "SUMMACARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 106855 . This is a "KAISER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 7775149 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000355013 . This is a "ANTHEM BLUE CROSS/BLUE SH" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 91378 . This is a "QUALCHOICE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: P00203912 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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