Provider Demographics
NPI:1912976473
Name:ANTONELLI, GIUSEPPE (MD)
Entity Type:Individual
Prefix:DR
First Name:GIUSEPPE
Middle Name:
Last Name:ANTONELLI
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 1:6789 RIDGE RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-5649
Mailing Address - Country:US
Mailing Address - Phone:440-743-7100
Mailing Address - Fax:440-743-7101
Practice Address - Street 1:6789 RIDGE RD
Practice Address - Street 2:SUITE 108
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5649
Practice Address - Country:US
Practice Address - Phone:440-743-7100
Practice Address - Fax:440-743-7101
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH45166174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0484131Medicaid
OH0484131Medicaid
OHAN0510161Medicare ID - Type UnspecifiedPROVDER ID