Provider Demographics
NPI:1952384307
Name:GARRITANO, NICHOLAS MATTHEW (DO)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:MATTHEW
Last Name:GARRITANO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3660 STARRS CENTRE DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-8506
Mailing Address - Country:US
Mailing Address - Phone:330-702-1606
Mailing Address - Fax:330-702-0160
Practice Address - Street 1:3660 STARRS CENTRE DR
Practice Address - Street 2:SUITE 2
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-8506
Practice Address - Country:US
Practice Address - Phone:440-366-5600
Practice Address - Fax:440-366-6766
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH34004414207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0798194OtherAETNA
OH0920347Medicaid
OH000000532429OtherANTHEM
OH000000532429OtherANTHEM
OHH378970Medicare PIN