Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 35120704 | OH |
N | 208200000X | Surgeon | 35120704 | OH |
N | 208600000X | Surgeon | 35120704 | OH |
N | 208200000X | Surgeon | MD454338 | PA |
N | 208600000X | Surgeon | MD454338 | PA |
NPI | 1548577596 |
---|---|
Provider Name | Mr. Thomas Joseph Chirichella III |
First Address | Youngstown, OH 44504-1006 |
Second Address | Youngstown, OH 44504-1006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2010 |
Last Update Date | 19/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0139225 | (05) | OH |