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General NPI Number Information
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NPI Number | 1639170426
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Entity Type | Organization
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Legal Business Name | PETER M BARNOVSKY DO INC
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Dates
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Enumeration Date | 08/03/2005
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Last Update Date | 06/16/2008
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Provider Practice Location Address
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Address Line | 500 WAKEFIELD DR
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City | CORTLAND
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State | OH
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Zip | 44410-1504
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Country | US
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Telephone | 330-638-4010
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Fax | 330-638-1540
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Provider Business Mailing Address
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Address Line | 500 WAKEFIELD DR
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City | CORTLAND
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State | OH
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Zip | 44410-1504
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Country | US
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Telephone | 330-638-4010
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Fax | 330-638-1540
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. TRACI SUE WOLFORD
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Credential |
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Telephone | 330-638-4010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 34-00-5712
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License Number State | OH
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