Healthcare Provider Details

I. General information

NPI: 1649247529
Provider Name (Legal Business Name): JASON RICHARD DELATORE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 BELMONT AVE
YOUNGSTOWN OH
44504-1006
US

IV. Provider business mailing address

1044 BELMONT AVE
YOUNGSTOWN OH
44504-1006
US

V. Phone/Fax

Practice location:
  • Phone: 330-744-2118
  • Fax: 330-747-6843
Mailing address:
  • Phone: 330-744-2118
  • Fax: 330-747-6843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number35.082322
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: