Healthcare Provider Details

I. General information

NPI: 1649268426
Provider Name (Legal Business Name): GERALD RICHARD ROBUSTO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: RICH ROBUSTO D.O.

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 07/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3919 CENTER RD
BRUNSWICK OH
44212-3087
US

IV. Provider business mailing address

3919 CENTER RD
BRUNSWICK OH
44212-3087
US

V. Phone/Fax

Practice location:
  • Phone: 220-558-0405
  • Fax: 330-558-0421
Mailing address:
  • Phone: 220-558-0405
  • Fax: 330-558-0421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34007490R
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: