Healthcare Provider Details

I. General information

NPI: 1780667139
Provider Name (Legal Business Name): PIERRE A VAUTHY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 09/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 HUGHES DR HMT SUITE 640
TOLEDO OH
43606-3845
US

IV. Provider business mailing address

2121 HUGHES DR HMT SUITE 640
TOLEDO OH
43606-3845
US

V. Phone/Fax

Practice location:
  • Phone: 419-291-2207
  • Fax: 419-479-6998
Mailing address:
  • Phone: 419-291-2207
  • Fax: 419-479-6998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number35037406V
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number35034706
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: