Basic Information
| Provider Information | |||||||||
| NPI: | 1356007116 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | USACS CRITICAL CARE MEDICINE SERVICES EAST, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4535 DRESSLER RD NW | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 447182545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3309944409 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9901 MEDICAL CENTER DR | ||||||||
| Address2: | |||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208503357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3309944409 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2021 | ||||||||
| LastUpdateDate: | 04/13/2022 | ||||||||
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| AuthorizedOfficialLastName: | BAGNOLI | ||||||||
| AuthorizedOfficialFirstName: | DOMINIC | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE CHAIRMAN | ||||||||
| AuthorizedOfficialTelephone: | 3309944409 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | JR. | ||||||||
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| NPICertificationDate: | 04/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
No ID Information.