Provider Demographics
NPI:1639170426
Name:PETER M BARNOVSKY DO INC
Entity Type:Organization
Organization Name:PETER M BARNOVSKY DO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:WOLFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-638-4010
Mailing Address - Street 1:500 WAKEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44410-1504
Mailing Address - Country:US
Mailing Address - Phone:330-638-4010
Mailing Address - Fax:330-638-1540
Practice Address - Street 1:500 WAKEFIELD DR
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:OH
Practice Address - Zip Code:44410-1504
Practice Address - Country:US
Practice Address - Phone:330-638-4010
Practice Address - Fax:330-638-1540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-03
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-5712207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0157735Medicaid
OHY30067Medicare UPIN
OH9351711Medicare PIN