Provider Demographics
NPI:1225101132
Name:AMADIO, CARMEN JOSEPH (CPED)
Entity Type:Individual
Prefix:MR
First Name:CARMEN
Middle Name:JOSEPH
Last Name:AMADIO
Suffix:
Gender:M
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 BOARDMAN CANFIELD RD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-4808
Mailing Address - Country:US
Mailing Address - Phone:330-758-4011
Mailing Address - Fax:
Practice Address - Street 1:170 BOARDMAN CANFIELD RD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-4808
Practice Address - Country:US
Practice Address - Phone:330-758-4011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2022920Medicaid
OH0787390001Medicare ID - Type Unspecified