Provider Demographics
NPI:1154312874
Name:DISIMONE, ROBERT N (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:N
Last Name:DISIMONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2465 OAKWAY ST NW
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-5886
Mailing Address - Country:US
Mailing Address - Phone:330-494-9541
Mailing Address - Fax:330-494-9540
Practice Address - Street 1:2465 OAKWAY ST NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-5886
Practice Address - Country:US
Practice Address - Phone:330-494-9541
Practice Address - Fax:330-494-9540
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35 02 66122085N0904X, 2085R0202X
OH35.026612207UN0903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207UN0903XAllopathic & Osteopathic PhysiciansNuclear MedicineIn Vivo & In Vitro Nuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0302354Medicaid
OH0302354Medicaid
OHDI7286441Medicare ID - Type UnspecifiedMEDICARE