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Organization
PATRIO D TISMO PA INC
Active
Organization
PATRIO D TISMO PA INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATRIO D TISMO M.D. (OWNER)
(740) 532-0059
Entity
Organization
Contact information
Practice address
107 NORTH 3RD STREET, IRONTON, OH 45638
(740) 532-0059
(740) 532-0380
Mailing address
P.O. BOX 500, 107 NORTH 3RD STREET, IRONTON, OH 45638
(740) 532-0059
(740) 532-0380
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
33966
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0175706
—
OH
Enumeration date
11/18/2010
Last updated
10/18/2011
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