Provider Demographics
NPI:1629078365
Name:CONFORTO, JAMES R (MD)
Entity Type:Individual
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First Name:JAMES
Middle Name:R
Last Name:CONFORTO
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Gender:M
Credentials:MD
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Mailing Address - Street 1:21245 LORAIN RD
Mailing Address - Street 2:LL100
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126-2146
Mailing Address - Country:US
Mailing Address - Phone:440-331-6855
Mailing Address - Fax:440-331-9105
Practice Address - Street 1:21245 LORAIN RD
Practice Address - Street 2:LL100
Practice Address - City:FAIRVIEW PARK
Practice Address - State:OH
Practice Address - Zip Code:44126-2146
Practice Address - Country:US
Practice Address - Phone:440-331-6855
Practice Address - Fax:440-331-9105
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2012-12-22
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Provider Licenses
StateLicense IDTaxonomies
OH36039945C207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0461692Medicare PIN
OHA78451Medicare UPIN