=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750561643
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRIMARY CARE PHYSICIANS OF STOW, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2007
-----------------------------------------------------
Last Update Date | 11/07/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3917 DARROW RD
-----------------------------------------------------
City | STOW
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44224-2621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-686-8100
-----------------------------------------------------
Fax | 330-686-8102
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3917 DARROW RD
-----------------------------------------------------
City | STOW
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44224-2621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-686-8100
-----------------------------------------------------
Fax | 330-686-8102
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. PENNIE R MARCHETTI
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 330-686-8100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 35063489M
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------