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Organization
JEROME M PRIVITERA DPM, INC.
Active
Organization
JEROME M PRIVITERA DPM, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEROME M PRIVITERA DPM (OWNER)
(440) 205-5878
Entity
Organization
Contact information
Practice address
9485 MENTOR AVE, SUITE 200, MENTOR, OH 44060-8723
(440) 205-5878
(440) 205-5875
Mailing address
9485 MENTOR AVE, SUITE 200, MENTOR, OH 44060-8723
(440) 205-5878
(440) 205-5875
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
OH001535
OH
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
OH002454
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2310636
—
OH
05
—
2310654
—
OH
05
—
2310663
—
OH
Enumeration date
10/23/2006
Last updated
10/15/2012
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