1841569902 NPI number — DR GINA REGHETTI DO PC INC

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 1841569902 NPI number — DR GINA REGHETTI DO PC INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR GINA REGHETTI DO PC INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1841569902
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
THE 110 BUILDING
Provider Second Line Business Mailing Address:
110 EDWARD STREET, NW
Provider Business Mailing Address City Name:
WARREN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44483-1118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-847-3334
Provider Business Mailing Address Fax Number:
330-847-9301

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
THE 110 BUILDING
Provider Second Line Business Practice Location Address:
110 EDWARD STREET, NW
Provider Business Practice Location Address City Name:
WARREN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44483-1118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-847-3334
Provider Business Practice Location Address Fax Number:
330-847-9301
Provider Enumeration Date:
12/19/2011

Additional Information

Authorized Official

Authorized Official Last Name:
REGHETTI
Authorized Official First Name:
DR. GINA
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN/SURGEON
Authorized Official Telephone Number:
330-847-3334

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  34-006816-R , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QH0100X , with the licence number: 34-006816-R , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0850X , with the licence number: 34-006816-R , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM2500X , with the licence number: 34-006816-R , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2300X , with the licence number: 34-006816-R , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0405X , with the licence number: 34-006816-R , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1300X , with the licence number: 34-006816-R , 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: 000012833-00 . This is a "OHIO BUREAU OF WORKERS' COMPENSATION CERTIFIED" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 34-006816-R . This is a "STATE OF OHIO MEDICAL LICENSE # 34-006816-R" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2174418 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 36D2026176 . This is a "CLIA WAIVER CERTIFICATE # 36D2026176 ACUTE OPIOID DETOX CLINIC, U.S.A." identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 8873 . This is a "AMERICAN OSTEOPATHIC BOARD OF FAMILY PHYSICIANS BOARD CERTIFICATION" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: RE 4018311 . This is a "MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 064509 . This is a "AOA # AMERICAN OSTEOPATHIC ASSOCIATION ID# 064509" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: H051310 . This is a "MEDICARE ID AS OF 7-17-2013" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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