Healthcare Provider Details

I. General information

NPI: 1629212584
Provider Name (Legal Business Name): CHARLES SPIRTOS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2009
Last Update Date: 10/16/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 BELMONT AVE
YOUNGSTOWN OH
44504-1106
US

IV. Provider business mailing address

1815 BELMONT AVE
YOUNGSTOWN OH
44504-1106
US

V. Phone/Fax

Practice location:
  • Phone: 330-740-9200
  • Fax:
Mailing address:
  • Phone: 330-740-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35.094750
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License Number35.094750
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: