Basic Information
Provider Information | |||||||||
NPI: | 1740286673 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SCARPONE | ||||||||
FirstName: | MICHAEL | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | DO | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 380 SUMMIT AVE | ||||||||
Address2: | MSO PHYSICIAN BILLING | ||||||||
City: | STEUBENVILLE | ||||||||
State: | OH | ||||||||
PostalCode: | 439522667 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7402837597 | ||||||||
FaxNumber: | 7402837190 | ||||||||
Practice Location | |||||||||
Address1: | 3151 JOHNSON RD STE 2 | ||||||||
Address2: |   | ||||||||
City: | STEUBENVILLE | ||||||||
State: | OH | ||||||||
PostalCode: | 439522362 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7402663866 | ||||||||
FaxNumber: | 7402663865 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/24/2005 | ||||||||
LastUpdateDate: | 05/12/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 05/12/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RS0010X | 05007044E | PA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Sports Medicine | 207RS0010X | 1113 | WV | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Sports Medicine | 207RS0010X | 34-0043305 | OH | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Sports Medicine |
ID Information
ID | Type | State | Issuer | Description | 0671732 | 05 | OH |   | MEDICAID | 250008191 | 01 | OH | RR MEDICARE | OTHER | 10008658340001 | 05 | PA |   | MEDICAID |