Provider Demographics
NPI:1669456737
Name:SZEMETYLO, VICTOR (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:
Last Name:SZEMETYLO
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 1:945 BETHESDA DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-1880
Mailing Address - Country:US
Mailing Address - Phone:740-454-8193
Mailing Address - Fax:740-454-1470
Practice Address - Street 1:999 GARDEN RD
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-1330
Practice Address - Country:US
Practice Address - Phone:740-454-8193
Practice Address - Fax:740-454-1470
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-062815207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
101974OtherBLACK LUNG
OH000000119763OtherANTHEM BLUE CROSS BLUE SHEILD
OH0876100Medicaid
101974OtherBLACK LUNG
OH000000119763OtherANTHEM BLUE CROSS BLUE SHEILD
OH0876100Medicaid