Provider Demographics
NPI:1235612870
Name:SCARLATO, COREY RAYMOND
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:RAYMOND
Last Name:SCARLATO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4273 FONTENAY
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-2872
Mailing Address - Country:US
Mailing Address - Phone:513-338-6530
Mailing Address - Fax:
Practice Address - Street 1:3636 MUDDY CREEK RD STE A
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-2081
Practice Address - Country:US
Practice Address - Phone:513-302-2672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH167749146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic