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General NPI Number Information
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NPI Number | 1215356050
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Entity Type | Organization
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Legal Business Name | PETER M DEVITO MD INC
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Dates
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Enumeration Date | 04/09/2014
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Last Update Date | 04/09/2014
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Provider Practice Location Address
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Address Line | 7600 SOUTHERN BLVD SUITE #2
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City | YOUNGSTOWN
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State | OH
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Zip | 44512-6085
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Country | US
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Telephone | 330-758-3985
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Fax |
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Provider Business Mailing Address
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Address Line | 7600 SOUTHERN BLVD SUITE #2
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City | YOUNGSTOWN
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State | OH
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Zip | 44512-6085
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Country | US
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Telephone | 330-758-3985
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. PETER M DE VITO
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Credential | MD
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Telephone | 330-758-3985
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 35064590
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License Number State | OH
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