1609075720 NPI number — DR. DARREN P DI IULIO DPM

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609075720 NPI number — DR. DARREN P DI IULIO DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DI IULIO
Provider First Name:
DARREN
Provider Middle Name:
P
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1609075720
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/06/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 635283
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45263-5283
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-212-0175
Provider Business Mailing Address Fax Number:
859-441-3698

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
525 ALEXANDRIA PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTHGATE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41071
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-212-0175
Provider Business Practice Location Address Fax Number:
859-441-3698
Provider Enumeration Date:
07/18/2007

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: 213ES0103X , with the licence number:  3464 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0131X , with the licence number: 00326 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X , with the licence number: 00326 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000611804 . This is a "ANTHEM PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9944851 . This is a "CIGNA PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9592120 . This is a "AETNA PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1235152448 . This is a "GRP NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 80900004 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100075840 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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