Provider Demographics
NPI:1932166899
Name:BARONI, VINCE (LPO; LPED)
Entity Type:Individual
Prefix:MR
First Name:VINCE
Middle Name:
Last Name:BARONI
Suffix:
Gender:M
Credentials:LPO; LPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9470 WHALERS CV
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-4576
Mailing Address - Country:US
Mailing Address - Phone:440-266-0250
Mailing Address - Fax:440-266-0251
Practice Address - Street 1:7322 CENTER ST
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-5802
Practice Address - Country:US
Practice Address - Phone:440-266-0250
Practice Address - Fax:440-266-0251
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPO185; LPED31744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0161051Medicaid
OH0985340001Medicare ID - Type UnspecifiedCHARDON
OH0985340003Medicare ID - Type UnspecifiedMENTOR
OH0161051Medicaid