NPIMap

Organization Active NPI

Angelo F. Petrolla DPM

  • Podiatrist
  • Youngstown, OH
National Provider Identifier
1154591675
Registry record updated Nov 28, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
36.001767 Issued in OH
Legal business name
ANGELO F. PETROLLA DPM
Practice address
3507 Canfield Rd
Suite 7
Youngstown, OH 44511-2859
Phone
(330) 793-0566
Fax
(330) 793-5767
NPI assigned
Mar 12, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Joanne Schulick
Title
Office Manager
Phone
(330) 793-0566

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213E00000X 36.001767 OH Primary

Addresses

Primary practice location

3507 Canfield Rd
Suite 7
Youngstown, OH 44511-2859

Mailing address

3507 Canfield Rd
Suite 7
Youngstown, OH 44511-2859
Phone (330) 793-0566

Other identifiers 1

IdentifierTypeStateIssuer
0333697MedicaidOH

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1205280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354060800000",
    "number": "1154591675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3507 CANFIELD RD",
            "address_2": "SUITE 7",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445112859",
            "telephone_number": "330-793-0566",
            "fax_number": "330-793-5767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3507 CANFIELD RD",
            "address_2": "SUITE 7",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445112859",
            "telephone_number": "330-793-0566",
            "fax_number": "330-793-5767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANGELO F. PETROLLA DPM",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-12",
        "last_updated": "2012-11-28",
        "status": "A",
        "authorized_official_last_name": "SCHULICK",
        "authorized_official_first_name": "JOANNE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "330-793-0566"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": "OH",
            "license": "36.001767",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0333697",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Youngstown, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.