Healthcare Provider Details

I. General information

NPI: 1538736160
Provider Name (Legal Business Name): ANDRE MARANGONI ASPERTI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date: 12/01/2022
Reactivation Date: 12/20/2022

III. Provider practice location address

617 23RD ST STE 8B
ASHLAND KY
41101-2845
US

IV. Provider business mailing address

PO BOX 2379
ASHLAND KY
41105-2379
US

V. Phone/Fax

Practice location:
  • Phone: 606-408-1290
  • Fax: 606-408-6640
Mailing address:
  • Phone: 606-408-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number79528
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number62110
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number62110
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: