Healthcare Provider Details

I. General information

NPI: 1073772422
Provider Name (Legal Business Name): MICHAEL ROBERT PASCOLINI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 12/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8423 MARKET ST STE 205
BOARDMAN OH
44512-6778
US

IV. Provider business mailing address

8423 MARKET ST STE 205
BOARDMAN OH
44512-6778
US

V. Phone/Fax

Practice location:
  • Phone: 330-729-1934
  • Fax: 330-729-1861
Mailing address:
  • Phone: 330-729-1934
  • Fax: 330-729-1861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number34010076
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberOS014037
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: