Organization
OTHELLO R REPUYAN MD
Active
Other names
Meridian Pediatrics of Canton LLC
Organization subpart
No
Provider details
NPI number
Authorized official
OTHELLO R REPUYAN MD (PRESIDENT)
(330) 492-4277
Entity
Organization
Contact information
Practice address
4188 HOLIDAY ST NW, CANTON, OH 44718
(330) 492-4277
(330) 492-6973
Mailing address
PO BOX 80690, CANTON, OH 44708
(330) 833-5530
(330) 833-6085
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2651750
—
OH
Enumeration date
09/14/2006
Last updated
06/17/2008
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