Provider Demographics
NPI:1649247529
Name:DELATORE, JASON RICHARD (MD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:RICHARD
Last Name:DELATORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1044 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44504-1006
Mailing Address - Country:US
Mailing Address - Phone:330-744-2118
Mailing Address - Fax:330-747-6843
Practice Address - Street 1:1044 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44504-1006
Practice Address - Country:US
Practice Address - Phone:330-744-2118
Practice Address - Fax:330-747-6843
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0823222086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4108072OtherMEDICARE PTAN
PA1028546510001Medicaid
OH2414211Medicaid
OH2414211Medicaid
OHDE4108071Medicare ID - Type Unspecified