Provider Demographics
NPI:1376841635
Name:FACTOR, VIRGINIA MATEO (DO)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:MATEO
Last Name:FACTOR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:
Other - Last Name:MATEO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:401 DEVON PLACE
Mailing Address - Street 2:SUITE 215
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-6483
Mailing Address - Country:US
Mailing Address - Phone:330-673-9501
Mailing Address - Fax:330-673-8204
Practice Address - Street 1:401 DEVON PLACE
Practice Address - Street 2:SUITE 215
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-6483
Practice Address - Country:US
Practice Address - Phone:330-673-9501
Practice Address - Fax:330-673-8204
Is Sole Proprietor?:No
Enumeration Date:2011-03-09
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.010852207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0108844Medicaid
OHH390300Medicare PIN