Healthcare Provider Details

I. General information

NPI: 1558523563
Provider Name (Legal Business Name): JONATHAN PAUL CONGENI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 05/12/2020
Certification Date: 05/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2726 FULTON DR NW
CANTON OH
44718-3506
US

IV. Provider business mailing address

2726 FULTON DR NW
CANTON OH
44718-3506
US

V. Phone/Fax

Practice location:
  • Phone: 330-455-5011
  • Fax: 330-588-7127
Mailing address:
  • Phone: 330-455-5011
  • Fax: 330-588-7127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number35.097867
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: