Provider Demographics
NPI:1386622298
Name:DEGIDIO, ERNEST (DO)
Entity type:Individual
Prefix:
First Name:ERNEST
Middle Name:
Last Name:DEGIDIO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5001 TRANSPORTATION DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SHEFFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44054-2849
Mailing Address - Country:US
Mailing Address - Phone:440-328-3420
Mailing Address - Fax:216-201-6365
Practice Address - Street 1:5001 TRANSPORTATION DR
Practice Address - Street 2:SUITE 300
Practice Address - City:SHEFFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44054-2849
Practice Address - Country:US
Practice Address - Phone:440-328-3420
Practice Address - Fax:216-201-6365
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008333D207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2494706Medicaid
OH000000378866OtherANTHEM BCBS
OHDE4141023Medicare ID - Type Unspecified
OH2494706Medicaid