Provider Demographics
NPI:1114069325
Name:CO, VICTORIANO (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTORIANO
Middle Name:
Last Name:CO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 NILLES RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-2634
Mailing Address - Country:US
Mailing Address - Phone:513-829-5306
Mailing Address - Fax:
Practice Address - Street 1:511 NILLES RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-2634
Practice Address - Country:US
Practice Address - Phone:513-829-5306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-03-3128-C208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0161168Medicaid
OH0161168Medicaid