Healthcare Provider Details

I. General information

NPI: 1083242747
Provider Name (Legal Business Name): STEPHAN A SAMMARTINO IV CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 09/16/2020
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PERKINS SQ
AKRON OH
44308-1063
US

IV. Provider business mailing address

1 PERKINS SQ
AKRON OH
44308-1063
US

V. Phone/Fax

Practice location:
  • Phone: 305-438-4523
  • Fax: 330-543-3761
Mailing address:
  • Phone: 330-543-8452
  • Fax: 330-543-3761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.025899
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: