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NPI Code Detail

MEDICARE: DR. PETER FANTON D.O.

MEDICARE:  DR. PETER  FANTON  D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician34002559OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1386636470
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PETER FANTON D.O.
Provider Business Mailing Address
First Line : 221 W 8TH ST
Second Line :
City : LORAIN
State : OH
Zip : 44052-1817
Country : US
Telephone Number : 440-245-4480
Fax Number :
Provider Business Practice Location Address
First Line : 221 W 8TH ST
Second Line :
City : LORAIN
State : OH
Zip : 44052-1817
Country : US
Telephone Number : 440-245-4480
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2005
Last Update Date : 07/08/2007

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Directions to “ DR. PETER FANTON D.O.” Practice Location

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