Provider Demographics
NPI:1952467680
Name:IRINEO P PANTANGCO MD INC
Entity Type:Organization
Organization Name:IRINEO P PANTANGCO MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IRINEO
Authorized Official - Middle Name:
Authorized Official - Last Name:PANTANGCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-235-2326
Mailing Address - Street 1:PO BOX 13149
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-0149
Mailing Address - Country:US
Mailing Address - Phone:614-235-2326
Mailing Address - Fax:614-235-5194
Practice Address - Street 1:6415 E LIVINGSTON AVE
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-3563
Practice Address - Country:US
Practice Address - Phone:614-864-8005
Practice Address - Fax:614-235-5194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2468020Medicaid
OH2468020Medicaid