Provider Demographics
NPI:1578960845
Name:VICTORIANO T. CO, MD, INC.
Entity Type:Organization
Organization Name:VICTORIANO T. CO, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:CO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-829-5306
Mailing Address - Street 1:511 NILLES RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-2634
Mailing Address - Country:US
Mailing Address - Phone:513-829-5306
Mailing Address - Fax:513-829-6004
Practice Address - Street 1:511 NILLES RD
Practice Address - Street 2:SUITE A
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-2634
Practice Address - Country:US
Practice Address - Phone:513-829-5306
Practice Address - Fax:513-829-6004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-02
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35078144261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2221303Medicaid