Provider Demographics
NPI:1457554842
Name:CLINICIANS IN INFECTIOUS DISEASES,INC
Entity Type:Organization
Organization Name:CLINICIANS IN INFECTIOUS DISEASES,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:FIORENTINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-454-7722
Mailing Address - Street 1:128 WERTZ AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-4196
Mailing Address - Country:US
Mailing Address - Phone:330-454-7722
Mailing Address - Fax:330-454-7834
Practice Address - Street 1:128 WERTZ AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-4196
Practice Address - Country:US
Practice Address - Phone:330-454-7722
Practice Address - Fax:330-454-7834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34071905174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHG54931Medicare UPIN
OH6362610001Medicare NSC