Provider Demographics
NPI:1912064528
Name:JANOLO, OLIVER L (MD)
Entity type:Individual
Prefix:
First Name:OLIVER
Middle Name:L
Last Name:JANOLO
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 1:975 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44310-1456
Mailing Address - Country:US
Mailing Address - Phone:330-762-6246
Mailing Address - Fax:330-376-7491
Practice Address - Street 1:975 N MAIN ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44310-1456
Practice Address - Country:US
Practice Address - Phone:330-762-6246
Practice Address - Fax:330-376-7491
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.088995207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2739166Medicaid
4201439Medicare PIN
OH2739166Medicaid