Provider Demographics
NPI:1063682052
Name:NICHOLAS P DEPIZZO DO INC
Entity Type:Organization
Organization Name:NICHOLAS P DEPIZZO DO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:DEPIZZO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-759-0435
Mailing Address - Street 1:4991 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-1017
Mailing Address - Country:US
Mailing Address - Phone:330-759-0435
Mailing Address - Fax:
Practice Address - Street 1:4991 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-1017
Practice Address - Country:US
Practice Address - Phone:330-759-0435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007530D207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1063682052OtherMEDICARE NPI
OH1023086816OtherMEDICARE NPI