Provider Demographics
NPI:1063489714
Name:CIAMBOTTI, VINCENT A (DO)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:A
Last Name:CIAMBOTTI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6 E SHENANGO ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SHARPSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16150-1122
Mailing Address - Country:US
Mailing Address - Phone:724-962-7819
Mailing Address - Fax:724-962-5405
Practice Address - Street 1:6 E SHENANGO ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SHARPSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16150-1122
Practice Address - Country:US
Practice Address - Phone:724-962-7819
Practice Address - Fax:724-962-5405
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS002686L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000114382OtherANTHEM BC BS
OH0160927Medicaid
OH000000114382OtherANTHEM BC BS
PAD66385Medicare UPIN