Healthcare Provider Details

I. General information

NPI: 1316930100
Provider Name (Legal Business Name): JOHN JOSEPH VARGO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 01/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5480 NORQUEST BLVD
AUSTINTOWN OH
44515-1820
US

IV. Provider business mailing address

5480 NORQUEST BLVD
AUSTINTOWN OH
44515-1820
US

V. Phone/Fax

Practice location:
  • Phone: 330-799-8000
  • Fax: 330-799-8579
Mailing address:
  • Phone: 330-799-8000
  • Fax: 330-799-8579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number34-00-4553
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: