Provider Demographics
NPI:1710985163
Name:OLIVERIO, JON DOMINIC (DPM)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:DOMINIC
Last Name:OLIVERIO
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 1:1193 NORTON AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:NORTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-9516
Mailing Address - Country:US
Mailing Address - Phone:330-825-7878
Mailing Address - Fax:330-595-4729
Practice Address - Street 1:1193 NORTON AVE
Practice Address - Street 2:SUITE D
Practice Address - City:NORTON
Practice Address - State:OH
Practice Address - Zip Code:44203-9516
Practice Address - Country:US
Practice Address - Phone:330-825-7878
Practice Address - Fax:330-595-4729
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-00-2891-0213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0156343Medicaid
OHP01815036OtherRAILROAD MEDICARE
OH4204803Medicare PIN
OH0156343Medicaid
OHU56409Medicare UPIN
OH4204801Medicare PIN
OH00000031754OtherANTHEM BCBS
OH455620001OtherCARESOURCE
OHU56409Medicare UPIN
OH0156343Medicaid
OH4204801Medicare PIN
OHQ018744OtherHOMETOWN