Provider Demographics
NPI:1912196999
Name:DOMINIC F CONTI DO LTD
Entity Type:Organization
Organization Name:DOMINIC F CONTI DO LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:F
Authorized Official - Last Name:CONTI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-758-2346
Mailing Address - Street 1:PO BOX 3538
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44513-3538
Mailing Address - Country:US
Mailing Address - Phone:330-758-2346
Mailing Address - Fax:330-758-8698
Practice Address - Street 1:80 MARWOOD CIR
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-6249
Practice Address - Country:US
Practice Address - Phone:330-758-2346
Practice Address - Fax:330-758-8698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHY33695Medicare UPIN
OH9353211Medicare PIN