Provider Demographics
NPI:1619138690
Name:PIETROPAOLO, DOMENICO (MD)
Entity Type:Individual
Prefix:
First Name:DOMENICO
Middle Name:
Last Name:PIETROPAOLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6255A EMERALD PKWY
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-3300
Mailing Address - Country:US
Mailing Address - Phone:614-766-3344
Mailing Address - Fax:614-766-3330
Practice Address - Street 1:6255A EMERALD PKWY
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-3300
Practice Address - Country:US
Practice Address - Phone:614-766-3344
Practice Address - Fax:614-766-3330
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.093018208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0063170Medicaid