Provider Demographics
NPI:1205105897
Name:JAMES P. DAMBROGIO, DO, INC
Entity type:Organization
Organization Name:JAMES P. DAMBROGIO, DO, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:DAMBROGIO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-534-9737
Mailing Address - Street 1:212 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:HUBBARD
Mailing Address - State:OH
Mailing Address - Zip Code:44425-1656
Mailing Address - Country:US
Mailing Address - Phone:330-534-9737
Mailing Address - Fax:330-534-9739
Practice Address - Street 1:212 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:HUBBARD
Practice Address - State:OH
Practice Address - Zip Code:44425-1656
Practice Address - Country:US
Practice Address - Phone:330-534-9737
Practice Address - Fax:330-534-9739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-28
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA05-010481L207Q00000X
OHAX2962567207QA0401X
OH34-001861-D207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0116501Medicaid
E77950Medicare UPIN