Healthcare Provider Details

I. General information

NPI: 1407828304
Provider Name (Legal Business Name): GIORGIO JAMES VESCERA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 07/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2875 PARKMAN RD NW
WARREN OH
44485-1639
US

IV. Provider business mailing address

2875 PARKMAN RD NW
WARREN OH
44485-1639
US

V. Phone/Fax

Practice location:
  • Phone: 330-898-1486
  • Fax: 330-898-4530
Mailing address:
  • Phone: 330-898-1486
  • Fax: 330-898-4530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35-084263
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: