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General NPI Number Information
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NPI Number | 1841455185
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Entity Type | Organization
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Legal Business Name | GIORGIO VESCERA, LLC
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Dates
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Enumeration Date | 07/25/2008
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Last Update Date | 07/25/2008
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Provider Practice Location Address
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Address Line | 2875 PARKMAN RD NW
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City | WARREN
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State | OH
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Zip | 44485-1639
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Country | US
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Telephone | 330-898-1486
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Fax | 330-898-4530
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Provider Business Mailing Address
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Address Line | 2875 PARKMAN RD NW
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City | WARREN
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State | OH
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Zip | 44485-1639
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Country | US
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Telephone | 330-898-1486
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Fax | 330-898-4530
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Authorized Official
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Title or Position | OWNER
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Name | GIORGIO JAMES VESCERA
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Credential | MD
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Telephone | 330-898-1486
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 35-084263
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License Number State | OH
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