Basic Information
| Provider Information | |||||||||
| NPI: | 1063580199 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHIODO | ||||||||
| FirstName: | CATHERINE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.P.M. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1272 W MAIN ST | ||||||||
| Address2: | BUILDING #4 | ||||||||
| City: | NEWARK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430552004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403458800 | ||||||||
| FaxNumber: | 7403445829 | ||||||||
| Practice Location | |||||||||
| Address1: | 1272 W MAIN ST | ||||||||
| Address2: | BUILDING #4 | ||||||||
| City: | NEWARK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430552004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403458800 | ||||||||
| FaxNumber: | 7403445829 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2006 | ||||||||
| LastUpdateDate: | 09/23/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | 2643 | OH | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0794305 | 05 | OH | MEDICAID |