Healthcare Provider Details

I. General information

NPI: 1124028667
Provider Name (Legal Business Name): KATHRYN LORRAINE FACCINI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2005
Last Update Date: 11/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 ORIOLE DR
YOUNGSTOWN OH
44505-2245
US

IV. Provider business mailing address

98 ORIOLE DR
YOUNGSTOWN OH
44505-2245
US

V. Phone/Fax

Practice location:
  • Phone: 330-759-9004
  • Fax: 330-759-9005
Mailing address:
  • Phone: 330-759-9004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberMD424718
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number35.078694
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: