Basic Information
| Provider Information | |||||||||
| NPI: | 1669521423 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | RIGONI | ||||||||
| FirstName: | JUDITH | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 951 COMMERCE PKWY | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | LIMA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458044040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4199984575 | ||||||||
| FaxNumber: | 4199984586 | ||||||||
| Practice Location | |||||||||
| Address1: | 1005 BELLEFONTAINE AVE | ||||||||
| Address2: | SUITE 245 | ||||||||
| City: | LIMA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458042851 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4199988230 | ||||||||
| FaxNumber: | 4199988231 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2007 | ||||||||
| LastUpdateDate: | 04/20/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | TRN7740 | FL | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 35.092133 | OH | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 000000649830 | 01 | OH | ANTHEM | OTHER | 2239689 | 05 | OH | MEDICAID | 341935236076 | 01 | OH | CARESOURCE | OTHER | 05932 | 01 | OH | PARAMOUNT | OTHER |