MEDICARE: PETER M BARNOVSKY DO INC

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
1	207Q00000X	Family Medicine Physician	34-00-5712	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639170426
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PETER M BARNOVSKY DO INC

Provider Business Mailing Address
First Line	:	500 WAKEFIELD DR
Second Line	:
City	:	CORTLAND
State	:	OH
Zip	:	44410-1504
Country	:	US
Telephone Number	:	330-638-4010
Fax Number	:	330-638-1540

Provider Business Practice Location Address
First Line	:	500 WAKEFIELD DR
Second Line	:
City	:	CORTLAND
State	:	OH
Zip	:	44410-1504
Country	:	US
Telephone Number	:	330-638-4010
Fax Number	:	330-638-1540

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. TRACI SUE WOLFORD
Credential	:
Telephone Number	:	330-638-4010

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	06/16/2008

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