Provider Demographics
NPI:1174636732
Name:CATANZARO, PHILLIP J (MD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:J
Last Name:CATANZARO
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 1:2865 E COAST HWY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CORONA DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92625-2236
Mailing Address - Country:US
Mailing Address - Phone:949-207-3111
Mailing Address - Fax:
Practice Address - Street 1:5260 SMITH RD
Practice Address - Street 2:
Practice Address - City:BROOKPARK
Practice Address - State:OH
Practice Address - Zip Code:44142-1747
Practice Address - Country:US
Practice Address - Phone:216-265-4580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35029874C2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0394078Medicaid
OH920005180OtherMEDICARE RAILROAD
OHF07786Medicare UPIN
OH0394078Medicaid