Provider Demographics
NPI:1386712289
Name:BLEGGI, ALBERT M (MD)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:M
Last Name:BLEGGI
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 1:816 MCKAY COURT
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512
Mailing Address - Country:US
Mailing Address - Phone:330-726-2071
Mailing Address - Fax:330-726-9007
Practice Address - Street 1:819 MCKAY CT
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-5713
Practice Address - Country:US
Practice Address - Phone:330-726-2071
Practice Address - Fax:330-726-9007
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0509312085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0625416Medicaid
OH4032635Medicare ID - Type UnspecifiedBREAST CARE MAMMO VAN
OH0689598Medicare ID - Type UnspecifiedADVANCED RADIOLOGY
OH4032636Medicare ID - Type UnspecifiedTHE BREAST CARE CENTER
OH0625416Medicaid
OH0689597Medicare ID - Type UnspecifiedBOARDMAN XRAY
OH4032631Medicare ID - Type UnspecifiedLIBERTY MRI