Provider Demographics
NPI:1811061203
Name:OLIVETO, EUGENE CHARLES (MD)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:CHARLES
Last Name:OLIVETO
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 1:2510 BELLEVUE MEDICAL CENTER
Mailing Address - Street 2:#145A
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123
Mailing Address - Country:US
Mailing Address - Phone:402-779-7207
Mailing Address - Fax:402-779-7210
Practice Address - Street 1:2510 BELLEVUE MEDICAL CENTER
Practice Address - Street 2:#145A
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123
Practice Address - Country:US
Practice Address - Phone:402-779-7207
Practice Address - Fax:402-779-7210
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE124372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47060553400Medicaid
NE47060553400Medicaid
NE01938Medicare ID - Type Unspecified
093519Medicare PIN