Healthcare Provider Details

I. General information

NPI: 1629129432
Provider Name (Legal Business Name): THEODORE R ARLOTTO MAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 02/18/2022
Certification Date: 02/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6315 PEARL RD STE 301B
PARMA HEIGHTS OH
44130-3074
US

IV. Provider business mailing address

6315 PEARL ROAD SUITE 301B
PARMA HEIGHTS OH
44130-4133
US

V. Phone/Fax

Practice location:
  • Phone: 440-289-6977
  • Fax: 440-244-2743
Mailing address:
  • Phone: 440-289-6977
  • Fax: 440-845-1805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1700X
TaxonomyOcularist
License Number0.29
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: