Provider Demographics
NPI:1568493476
Name:DIGIACOMO, PETER E (DO)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:E
Last Name:DIGIACOMO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4151 HOLIDAY ST. NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718
Mailing Address - Country:US
Mailing Address - Phone:330-492-8001
Mailing Address - Fax:330-492-2080
Practice Address - Street 1:4151 HOLIDAY ST. NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718
Practice Address - Country:US
Practice Address - Phone:330-492-8001
Practice Address - Fax:330-492-2080
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34005303207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0855892Medicaid
160045665OtherRAILROAD MEDICARE
87539OtherQUALCHOICE
OH000000137195OtherANTHEM BLUE CROSS & BLUE
0798533OtherAETNA
1955296OtherCIGNA HEALTHCARE
OH000000137195OtherANTHEM BLUE CROSS & BLUE
87539OtherQUALCHOICE