Provider Demographics
NPI:1215009709
Name:PANTANGCO, IRINEO P JR (MD/MBA)
Entity Type:Individual
Prefix:
First Name:IRINEO
Middle Name:P
Last Name:PANTANGCO
Suffix:JR
Gender:M
Credentials:MD/MBA
Other - Prefix:
Other - First Name:IRINEO
Other - Middle Name:P
Other - Last Name:PANTANGCO
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:MD/MBA
Mailing Address - Street 1:5857 DYRHAM PARK
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-3656
Mailing Address - Country:US
Mailing Address - Phone:614-717-9722
Mailing Address - Fax:614-717-9722
Practice Address - Street 1:5857 DYRHAM PARK
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-3656
Practice Address - Country:US
Practice Address - Phone:614-717-9722
Practice Address - Fax:614-717-9722
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35100324207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0281985Medicaid
OH0281985Medicaid