Basic Information
| Provider Information | |||||||||
| NPI: | 1568493476 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DIGIACOMO | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4151 HOLIDAY ST. NW | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304928001 | ||||||||
| FaxNumber: | 3304922080 | ||||||||
| Practice Location | |||||||||
| Address1: | 4151 HOLIDAY ST. NW | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304928001 | ||||||||
| FaxNumber: | 3304922080 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 06/25/2015 | ||||||||
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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 | 34005303 | OH | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 0855892 | 05 | OH | MEDICAID | 160045665 | 01 | RAILROAD MEDICARE | OTHER | 87539 | 01 | QUALCHOICE | OTHER | 000000137195 | 01 | OH | ANTHEM BLUE CROSS & BLUE | OTHER | 0798533 | 01 | AETNA | OTHER | 1955296 | 01 | CIGNA HEALTHCARE | OTHER |