# JEROME M PRIVITERA DPM, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700969102
- **Authorized official:** JEROME M PRIVITERA DPM (OWNER)
- **Authorized official phone:** (440) 205-5878

## Contact information

- **Practice address:** 9485 MENTOR AVE, SUITE 200, MENTOR, OH 44060-8723
- **Practice address phone:** (440) 205-5878
- **Practice address fax:** (440) 205-5875
- **Mailing address:** 9485 MENTOR AVE, SUITE 200, MENTOR, OH 44060-8723
- **Mailing address phone:** (440) 205-5878
- **Mailing address fax:** (440) 205-5875

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213EP1101X | Primary Podiatric Medicine Podiatrist | OH001535 | OH | — |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | OH002454 | OH | Yes |

## Other

- **Enumeration date:** 10/23/2006
- **Last updated:** 10/15/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 2310636 | — | OH |
| 05 | — | 2310654 | — | OH |
| 05 | — | 2310663 | — | OH |