Basic Information
| Provider Information | |||||||||
| NPI: | 1174636732 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CATANZARO | ||||||||
| FirstName: | PHILLIP | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2865 E COAST HWY | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | CORONA DEL MAR | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926252236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9492073111 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5260 SMITH RD | ||||||||
| Address2: | |||||||||
| City: | BROOKPARK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441421747 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2162654580 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2006 | ||||||||
| LastUpdateDate: | 06/25/2014 | ||||||||
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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 | 2085R0001X | 35029874C | OH | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 0394078 | 05 | OH | MEDICAID | 920005180 | 01 | OH | MEDICARE RAILROAD | OTHER |