Provider Demographics
NPI:1104817881
Name:CIOTTI, ANNETTE AMELIA (DO)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:AMELIA
Last Name:CIOTTI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8300 TYLER BLVD
Mailing Address - Street 2:#300
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-4217
Mailing Address - Country:US
Mailing Address - Phone:440-205-1529
Mailing Address - Fax:440-205-0840
Practice Address - Street 1:8300 TYLER BLVD
Practice Address - Street 2:#300
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4217
Practice Address - Country:US
Practice Address - Phone:440-205-1529
Practice Address - Fax:440-205-0840
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008192207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000329708OtherANTHEM
OH2465998Medicaid
E21894Medicare UPIN
OH2465998Medicaid