Provider Demographics
NPI:1194942656
Name:ALLEGRO MEDICAL ARTS, LLC
Entity type:Organization
Organization Name:ALLEGRO MEDICAL ARTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:DEPASCALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-759-6750
Mailing Address - Street 1:1601 MOTOR INN DR
Mailing Address - Street 2:SUITE 240
Mailing Address - City:GIRARD
Mailing Address - State:OH
Mailing Address - Zip Code:44420-2420
Mailing Address - Country:US
Mailing Address - Phone:330-759-6750
Mailing Address - Fax:330-759-6755
Practice Address - Street 1:4866 WUNNENBERG WAY
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-4863
Practice Address - Country:US
Practice Address - Phone:513-942-6130
Practice Address - Fax:513-942-6139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========OtherTAX ID