Provider Demographics
NPI:1154508489
Name:JAMES S. TAVOLARIO DPM
Entity Type:Organization
Organization Name:JAMES S. TAVOLARIO DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR.
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:A
Authorized Official - Last Name:FERRANTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-369-4691
Mailing Address - Street 1:1457 CENTRAL PARKWAY AVE SE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-4458
Mailing Address - Country:US
Mailing Address - Phone:330-369-4691
Mailing Address - Fax:330-369-8379
Practice Address - Street 1:1457 CENTRAL PARKWAY AVE SE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-4458
Practice Address - Country:US
Practice Address - Phone:330-369-4691
Practice Address - Fax:330-369-8379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36 001556332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4258330001Medicare NSC