Provider Demographics
NPI:1376715284
Name:PROVENZANO, AARON
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:PROVENZANO
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 1:3204 JOHNSON RD
Mailing Address - Street 2:TERAMANA CANCER CENTER
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-2354
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3204 JOHNSON RD
Practice Address - Street 2:TERAMANA CANCER CENTER
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-2354
Practice Address - Country:US
Practice Address - Phone:740-266-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-31
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH011510207RH0003X
PAOS019706207RH0003X
WV2424207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology