Provider Demographics
NPI:1619087053
Name:PIETROLUNGO, JOSEPH F (DO FSVMB FACC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:F
Last Name:PIETROLUNGO
Suffix:
Gender:M
Credentials:DO FSVMB FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 ARCH ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1437
Mailing Address - Country:US
Mailing Address - Phone:330-376-7000
Mailing Address - Fax:330-376-1066
Practice Address - Street 1:95 ARCH ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1437
Practice Address - Country:US
Practice Address - Phone:330-376-7000
Practice Address - Fax:330-376-1066
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34004515207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0914185Medicaid
OH0884257Medicare PIN
OH0914185Medicaid