Provider Demographics
NPI:1083803357
Name:JOSEPH C LA MANCUSA MD
Entity Type:Organization
Organization Name:JOSEPH C LA MANCUSA MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:C
Authorized Official - Last Name:LA MANCUSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-425-5481
Mailing Address - Street 1:207 W WALLACE ST
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-1212
Mailing Address - Country:US
Mailing Address - Phone:419-425-5481
Mailing Address - Fax:419-425-8468
Practice Address - Street 1:207 W WALLACE ST
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-1212
Practice Address - Country:US
Practice Address - Phone:419-425-5481
Practice Address - Fax:419-425-8468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350574372084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSP03601Medicare PIN