Provider Demographics
NPI:1346281441
Name:D AMICO, THERESA (NP)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:D AMICO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 932085
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0001
Mailing Address - Country:US
Mailing Address - Phone:888-328-4492
Mailing Address - Fax:
Practice Address - Street 1:6707 POWERS BLVD
Practice Address - Street 2:104
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5455
Practice Address - Country:US
Practice Address - Phone:440-886-2509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-05098207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00212878OtherRAILROAD MEDICARE
OH2335888Medicaid
OHPONP04081Medicare ID - Type Unspecified
OHS83330Medicare UPIN