Provider Demographics
NPI:1912945965
Name:DPMGIAIMOPROH LLC
Entity Type:Organization
Organization Name:DPMGIAIMOPROH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:J
Authorized Official - Last Name:GIAMO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:740-456-5700
Mailing Address - Street 1:4342 GALLIA ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEW BOSTON
Mailing Address - State:OH
Mailing Address - Zip Code:45662-5562
Mailing Address - Country:US
Mailing Address - Phone:740-456-5700
Mailing Address - Fax:740-456-5711
Practice Address - Street 1:4342 GALLIA ST
Practice Address - Street 2:SUITE A
Practice Address - City:NEW BOSTON
Practice Address - State:OH
Practice Address - Zip Code:45662-5562
Practice Address - Country:US
Practice Address - Phone:740-456-5700
Practice Address - Fax:740-456-5711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36. 003338213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2424906Medicaid
OH5756810001Medicare NSC
OHU68124Medicare UPIN
OH2424906Medicaid