Provider Demographics
NPI:1649295353
Name:PENSIERO, CHRISTOPHER ANDREW (DPM)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:ANDREW
Last Name:PENSIERO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 324
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:OH
Mailing Address - Zip Code:44811-0324
Mailing Address - Country:US
Mailing Address - Phone:419-483-2329
Mailing Address - Fax:419-483-8920
Practice Address - Street 1:1400 W MAIN ST
Practice Address - Street 2:BLDG. 1, SUITE B
Practice Address - City:BELLEVUE
Practice Address - State:OH
Practice Address - Zip Code:44811-9088
Practice Address - Country:US
Practice Address - Phone:419-483-2329
Practice Address - Fax:419-483-8920
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36 001824213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0346414Medicaid
OH791480173OtherRAILROAD MEDICARE
OH0441316Medicare PIN
OH0441315Medicare PIN
OH0346414Medicaid