Provider Demographics
NPI:1497769707
Name:NORTHEASTERN OHIO INFECTIOUS DISEASE ASSOCIATION INC
Entity Type:Organization
Organization Name:NORTHEASTERN OHIO INFECTIOUS DISEASE ASSOCIATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:F
Authorized Official - Last Name:CUTRONA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-744-4369
Mailing Address - Street 1:PO BOX 2163
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44504-0163
Mailing Address - Country:US
Mailing Address - Phone:330-744-4369
Mailing Address - Fax:330-744-1728
Practice Address - Street 1:540 PARMALEE AVE
Practice Address - Street 2:STE. 610
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44510-1605
Practice Address - Country:US
Practice Address - Phone:330-744-4369
Practice Address - Fax:330-744-1728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0981817Medicaid
OH0981817Medicaid