Provider Demographics
NPI:1508635392
Name:PAYNE, PETER ANTHONY
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:ANTHONY
Last Name:PAYNE
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 1:158 N ROANOKE AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-2834
Mailing Address - Country:US
Mailing Address - Phone:330-937-0016
Mailing Address - Fax:
Practice Address - Street 1:158 N ROANOKE AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-2834
Practice Address - Country:US
Practice Address - Phone:330-937-0016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide