Provider Demographics
NPI:1225117575
Name:DEPERALTA, CLAUDIO A (MD)
Entity Type:Individual
Prefix:
First Name:CLAUDIO
Middle Name:A
Last Name:DEPERALTA
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 1:149 E SIMPSON ST
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-4219
Mailing Address - Country:US
Mailing Address - Phone:330-823-4424
Mailing Address - Fax:330-823-9589
Practice Address - Street 1:149 E SIMPSON ST
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-4219
Practice Address - Country:US
Practice Address - Phone:330-823-4424
Practice Address - Fax:330-823-9589
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35070562208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0319702Medicaid
OH20110438300OtherBWC
OH0319702Medicaid
OH0806915Medicare ID - Type Unspecified