Provider Demographics
NPI:1821098963
Name:CONTI, FREDERICK LEWIS (DPM)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:LEWIS
Last Name:CONTI
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 1:2660 W MARKET ST
Mailing Address - Street 2:101
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-4206
Mailing Address - Country:US
Mailing Address - Phone:330-867-9303
Mailing Address - Fax:330-867-9304
Practice Address - Street 1:2660 W MARKET ST
Practice Address - Street 2:101
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-4206
Practice Address - Country:US
Practice Address - Phone:330-867-9303
Practice Address - Fax:330-867-9304
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1577213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH48003502OtherRAIL ROAD MEDICARE
OH0197577Medicaid
0808080001OtherDMBRC
0808080001OtherDMBRC
OH48003502OtherRAIL ROAD MEDICARE