Provider Demographics
NPI:1427051317
Name:DEL PRINCE, GUY BARNABA (DPM)
Entity type:Individual
Prefix:DR
First Name:GUY
Middle Name:BARNABA
Last Name:DEL PRINCE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2139 W PROSPECT RD
Mailing Address - Street 2:EL GRANDE STEAKHOUSE PLAZA
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-6439
Mailing Address - Country:US
Mailing Address - Phone:440-998-7505
Mailing Address - Fax:
Practice Address - Street 1:2139 W PROSPECT RD
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-6439
Practice Address - Country:US
Practice Address - Phone:440-998-7505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2972213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1525116OtherUMHA
OH2003656Medicaid
000000116450OtherANTHEM
OH1156710001OtherDMERC
OH480021052OtherRR MEDICARE
OH1156710001OtherDMERC
OH1525116OtherUMHA