Basic Information
| Provider Information | |||||||||
| NPI: | 1669456737 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SZEMETYLO | ||||||||
| FirstName: | VICTOR | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 945 BETHESDA DRIVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ZANESVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437011880 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404548193 | ||||||||
| FaxNumber: | 7404541470 | ||||||||
| Practice Location | |||||||||
| Address1: | 999 GARDEN RD | ||||||||
| Address2: | |||||||||
| City: | ZANESVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437011330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404548193 | ||||||||
| FaxNumber: | 7404541470 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2005 | ||||||||
| LastUpdateDate: | 06/03/2014 | ||||||||
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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 | 207RG0100X | 35-062815 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 101974 | 01 | BLACK LUNG | OTHER | 000000119763 | 01 | OH | ANTHEM BLUE CROSS BLUE SHEILD | OTHER | 0876100 | 05 | OH | MEDICAID |