Provider Demographics
NPI:1659405595
Name:VINCENT A CIAMBOTTI, D.O. INC
Entity Type:Organization
Organization Name:VINCENT A CIAMBOTTI, D.O. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:A
Authorized Official - Last Name:CIAMBOTTI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:724-962-7819
Mailing Address - Street 1:6 E SHENANGO ST
Mailing Address - Street 2:STE 1
Mailing Address - City:SHARPSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16150-1122
Mailing Address - Country:US
Mailing Address - Phone:724-962-7819
Mailing Address - Fax:724-962-5405
Practice Address - Street 1:6 E SHENANGO ST
Practice Address - Street 2:STE 1
Practice Address - City:SHARPSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16150-1122
Practice Address - Country:US
Practice Address - Phone:724-962-7819
Practice Address - Fax:724-962-5405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS 002686L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAD66385Medicare UPIN
PACI014937Medicare ID - Type Unspecified