Basic Information
| Provider Information | |||||||||
| NPI: | 1083935936 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NERONE | ||||||||
| FirstName: | VINCENT | ||||||||
| MiddleName: | STUART | ||||||||
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| Credential: | D.P.M | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 449 | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457500449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403744500 | ||||||||
| FaxNumber: | 7403745887 | ||||||||
| Practice Location | |||||||||
| Address1: | 805 FARSON ST. | ||||||||
| Address2: | SUITE 113 | ||||||||
| City: | BELPRE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404233207 | ||||||||
| FaxNumber: | 7404233227 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2010 | ||||||||
| LastUpdateDate: | 06/20/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | 36.003670 | OH | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist |
ID Information
| ID | Type | State | Issuer | Description | 0086628 | 05 | OH | MEDICAID | P01306389 | 01 | OH | RAILROAD MEDICARE - MHCPI | OTHER | 3810026352 | 05 | WV | MEDICAID |