Healthcare Provider Details

I. General information

NPI: 1932166899
Provider Name (Legal Business Name): VINCE BARONI LPO; LPED
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7322 CENTER ST
MENTOR OH
44060-5802
US

IV. Provider business mailing address

9470 WHALERS CV
MENTOR OH
44060-4576
US

V. Phone/Fax

Practice location:
  • Phone: 440-266-0250
  • Fax: 440-266-0251
Mailing address:
  • Phone: 440-266-0250
  • Fax: 440-266-0251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License NumberLPO185; LPED3
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: