Healthcare Provider Details

I. General information

NPI: 1407950074
Provider Name (Legal Business Name): PETER M CATANZARO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 07/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3461 WARRENSVILLE CENTER RD STE 105
SHAKER HTS OH
44122-5227
US

IV. Provider business mailing address

PO BOX 74606
CLEVELAND OH
44194-0689
US

V. Phone/Fax

Practice location:
  • Phone: 216-383-0100
  • Fax: 216-383-6481
Mailing address:
  • Phone: 216-991-4180
  • Fax: 216-991-7329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35077773
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: