Basic Information
Provider Information | |||||||||
NPI: | 1023011137 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SETTONNI | ||||||||
FirstName: | LORETTA | ||||||||
MiddleName: | A | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | CAMPBELL | ||||||||
OtherFirstName: | LORETTA | ||||||||
OtherMiddleName: | A | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MD | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1735 27TH ST STE B06 | ||||||||
Address2: |   | ||||||||
City: | PORTSMOUTH | ||||||||
State: | OH | ||||||||
PostalCode: | 456622681 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7403568008 | ||||||||
FaxNumber: | 7403537900 | ||||||||
Practice Location | |||||||||
Address1: | 1805 27TH ST | ||||||||
Address2: |   | ||||||||
City: | PORTSMOUTH | ||||||||
State: | OH | ||||||||
PostalCode: | 456622640 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7403568117 | ||||||||
FaxNumber: | 4035312147 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/23/2005 | ||||||||
LastUpdateDate: | 12/18/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 12/18/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | ME86266 | FL | N |   | Other Service Providers | Specialist |   | 2085R0202X | 35076155 | OH | Y |   | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
ID | Type | State | Issuer | Description | 268384900 | 05 | FL |   | MEDICAID | 3114141 | 05 | OH |   | MEDICAID | 7100191080 | 05 | KY |   | MEDICAID |