Provider Demographics
NPI:1710957626
Name:BALMENTI, PHILLIP E (DPM)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:E
Last Name:BALMENTI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 MCKAY CT
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-5790
Mailing Address - Country:US
Mailing Address - Phone:330-758-1422
Mailing Address - Fax:
Practice Address - Street 1:827 MCKAY CT
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-5790
Practice Address - Country:US
Practice Address - Phone:330-758-1422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36001644213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0240895Medicaid
OH341223965026OtherCARESOURCE
OH000000116349OtherANTHEM
OH34122396500OtherWORKMANS COPM
OH341229365001OtherMEDICAL MUTUAL OF OHIO
OH34122396500OtherWORKMANS COPM
OH0240895Medicaid
OHBA0393405Medicare ID - Type Unspecified