Provider Demographics
NPI:1992097182
Name:MARCANTONI-NEVERS, VERONICA (MD)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:MARCANTONI-NEVERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VERONICA
Other - Middle Name:
Other - Last Name:MARCANTONI PACHECO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5070 BRADENTON AVE
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-3520
Mailing Address - Country:US
Mailing Address - Phone:614-764-1777
Mailing Address - Fax:614-764-9555
Practice Address - Street 1:5070 BRADENTON AVE
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-3520
Practice Address - Country:US
Practice Address - Phone:614-764-1777
Practice Address - Fax:614-764-9555
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-06
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.122247207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0105985Medicaid