Provider Demographics
NPI:1841569902
Name:DR GINA REGHETTI DO PC INC
Entity Type:Organization
Organization Name:DR GINA REGHETTI DO PC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:DR. GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:REGHETTI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-847-3334
Mailing Address - Street 1:THE 110 BUILDING
Mailing Address - Street 2:110 EDWARD STREET, NW
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-1118
Mailing Address - Country:US
Mailing Address - Phone:330-847-3334
Mailing Address - Fax:330-847-9301
Practice Address - Street 1:THE 110 BUILDING
Practice Address - Street 2:110 EDWARD STREET, NW
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-1118
Practice Address - Country:US
Practice Address - Phone:330-847-3334
Practice Address - Fax:330-847-9301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-006816-R261Q00000X, 261QH0100X, 261QM0850X, 261QM1300X, 261QM2500X, 261QP2300X, 261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000012833-00OtherOHIO BUREAU OF WORKERS' COMPENSATION CERTIFIED
OH34-006816-ROtherSTATE OF OHIO MEDICAL LICENSE # 34-006816-R
OH2174418Medicaid
OH36D2026176OtherCLIA WAIVER CERTIFICATE # 36D2026176 ACUTE OPIOID DETOX CLINIC, U.S.A.
IL8873OtherAMERICAN OSTEOPATHIC BOARD OF FAMILY PHYSICIANS BOARD CERTIFICATION
OHRE 4018311OtherMEDICARE
OH064509OtherAOA # AMERICAN OSTEOPATHIC ASSOCIATION ID# 064509
OHH051310OtherMEDICARE ID AS OF 7-17-2013
OHRE 4018311OtherMEDICARE
OH064509OtherAOA # AMERICAN OSTEOPATHIC ASSOCIATION ID# 064509
OHH051310OtherMEDICARE ID AS OF 7-17-2013
OH2174418Medicaid