Healthcare Provider Details

I. General information

NPI: 1295812113
Provider Name (Legal Business Name): FRANKLIN E ANSEVIN PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 02/15/2021
Certification Date: 02/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 BELMONT AVE FL 2
YOUNGSTOWN OH
44504-1006
US

IV. Provider business mailing address

1044 BELMONT AVE FL 2
YOUNGSTOWN OH
44504-1006
US

V. Phone/Fax

Practice location:
  • Phone: 330-480-3990
  • Fax: 330-480-3522
Mailing address:
  • Phone: 330-480-3990
  • Fax: 330-480-3522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.001666
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: