Provider Demographics
NPI:1457315111
Name:DIBARTOLOMEO, EMILY (PA)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:DIBARTOLOMEO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3925 EMBASSY PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44333-8400
Mailing Address - Country:US
Mailing Address - Phone:330-668-4040
Mailing Address - Fax:330-668-4077
Practice Address - Street 1:3925 EMBASSY PKWY STE 200
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44333-8400
Practice Address - Country:US
Practice Address - Phone:330-668-4055
Practice Address - Fax:330-668-4077
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.002121RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO42724279Medicaid
CO42724279Medicaid