Basic Information
| Provider Information | |||||||||
| NPI: | 1083613467 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | D'AMATO | ||||||||
| FirstName: | LUIGI | ||||||||
| MiddleName: | O | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3740 W SYLVANIA AVE | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436234461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194736622 | ||||||||
| FaxNumber: | 4194736627 | ||||||||
| Practice Location | |||||||||
| Address1: | 3740 W SYLVANIA AVE | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436234461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194736622 | ||||||||
| FaxNumber: | 4194736627 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2005 | ||||||||
| LastUpdateDate: | 07/24/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 35041551 | OH | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 160041504 | 01 | OH | RRMC | OTHER | 2083291 | 01 | OH | AETNA | OTHER | 000000141249 | 01 | OH | ANTHEM | OTHER | 07-01478 | 01 | OH | UHC | OTHER | 00116 | 01 | OH | PARAMOUNT | OTHER | 0429914 | 05 | OH | MEDICAID |