Healthcare Provider Details

I. General information

NPI: 1386064400
Provider Name (Legal Business Name): MR. JAMES JOSEPH RECTENWALD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2014
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6505 MARKET ST
BOARDMAN OH
44512-3457
US

IV. Provider business mailing address

6505 MARKET ST
BOARDMAN OH
44512-3457
US

V. Phone/Fax

Practice location:
  • Phone: 330-746-9200
  • Fax: 330-746-9201
Mailing address:
  • Phone: 330-746-9200
  • Fax: 330-746-9201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number34.012712
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: