1558363531 NPI number — DR. DORIS DIPRIMIO COREY DO

Table of content: MR. JASON CLIFFORD PATTILLO MPT (NPI 1497764252)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558363531 NPI number — DR. DORIS DIPRIMIO COREY DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COREY
Provider First Name:
DORIS
Provider Middle Name:
DIPRIMIO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

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:
1558363531
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
06/05/2006
NPI Reactivation Date:
11/06/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
390 REGAL OAKS CIRCLE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AURORA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-474-1351
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2365 EDISON BLVD
Provider Second Line Business Practice Location Address:
TWINSBURG URGENT CARE
Provider Business Practice Location Address City Name:
TWINSBURG
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44087
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-425-4385
Provider Business Practice Location Address Fax Number:
330-963-4783
Provider Enumeration Date:
08/10/2005

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: 207Q00000X , with the licence number:  34007478 , 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: 2306927 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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