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NPI Code Detail

MEDICARE: OHIO PODIATRIC PHYSICIANS AND SURGEONS GROUP, LLC

MEDICARE: OHIO PODIATRIC PHYSICIANS AND SURGEONS GROUP, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1213ES0103XFoot & Ankle Surgery Podiatrist
2213ES0131XFoot Surgery Podiatrist
3213EP1101XPrimary Podiatric Medicine Podiatrist

General Provider Information

NPI Number : 1285030684
Entity Type Code : Organization
Provider Name (Legal Business Name) : OHIO PODIATRIC PHYSICIANS AND SURGEONS GROUP, LLC
Provider Business Mailing Address
First Line : 8175 MARKET ST
Second Line :
City : YOUNGSTOWN
State : OH
Zip : 44512-6244
Country : US
Telephone Number : 330-629-8800
Fax Number : 330-758-4914
Provider Business Practice Location Address
First Line : 1450 S CANFIELD NILES RD
Second Line :
City : AUSTINTOWN
State : OH
Zip : 44515-4085
Country : US
Telephone Number : 330-270-2700
Fax Number : 330-792-2110
Authorized Official
Title or Position : MANAGING PARTNER
Name : LAWRENCE DIDOMENICO
Credential : DPM
Telephone Number : 330-629-8800
Provider Enumeration Date : 11/12/2014
Last Update Date : 11/12/2014

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