Healthcare Provider Details

I. General information

NPI: 1396716593
Provider Name (Legal Business Name): EDWARD F COSENTINO DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 04/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 N STATE ST
GIRARD OH
44420
US

IV. Provider business mailing address

603 N STATE ST
GIRARD OH
44420
US

V. Phone/Fax

Practice location:
  • Phone: 330-545-4993
  • Fax: 330-545-5200
Mailing address:
  • Phone: 330-545-4993
  • Fax: 330-545-5200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number2089
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number2089
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: