Healthcare Provider Details

I. General information

NPI: 1841455185
Provider Name (Legal Business Name): GIORGIO VESCERA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2008
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: GIORGIO JAMES VESCERA
Title or Position: OWNER
Credential: MD
Phone: 330-898-1486