Healthcare Provider Details

I. General information

NPI: 1386622298
Provider Name (Legal Business Name): ERNEST DEGIDIO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 12/15/2020
Certification Date: 12/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 TRANSPORTATION DR SUITE 300
SHEFFIELD VILLAGE OH
44054-2849
US

IV. Provider business mailing address

5001 TRANSPORTATION DR SUITE 300
SHEFFIELD VILLAGE OH
44054-2849
US

V. Phone/Fax

Practice location:
  • Phone: 440-328-3420
  • Fax: 216-201-6365
Mailing address:
  • Phone: 440-328-3420
  • Fax: 216-201-6365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34008333D
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: