Provider Demographics
NPI:1457422032
Name:VENTOSA, JOSE A (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:A
Last Name:VENTOSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 BOETTLER RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-9584
Mailing Address - Country:US
Mailing Address - Phone:330-899-0103
Mailing Address - Fax:330-899-0268
Practice Address - Street 1:1402 BOETTLER RD
Practice Address - Street 2:SUITE C
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-9584
Practice Address - Country:US
Practice Address - Phone:330-899-0103
Practice Address - Fax:330-899-0268
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35.056929207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0724461Medicaid
OH0724461Medicaid