Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 35-05-7140-M | OH |
NPI | 1003817420 |
---|---|
Provider Name | Dr. James V Martuccio JR. |
First Address | Warren, OH 44484 |
Second Address | Warren, OH 44484 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2005 |
Last Update Date | 01/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0822024 | (05) | OH |
E84843 | (02) |