Provider Demographics
NPI:1841455185
Name:GIORGIO VESCERA, LLC
Entity type:Organization
Organization Name:GIORGIO VESCERA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GIORGIO
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:VESCERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-898-1486
Mailing Address - Street 1:2875 PARKMAN RD NW
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44485-1639
Mailing Address - Country:US
Mailing Address - Phone:330-898-1486
Mailing Address - Fax:330-898-4530
Practice Address - Street 1:2875 PARKMAN RD NW
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44485-1639
Practice Address - Country:US
Practice Address - Phone:330-898-1486
Practice Address - Fax:330-898-4530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-084263208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2510812Medicaid