Basic Information
| Provider Information | |||||||||
| NPI: | 1821063454 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PALERMO | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | PETER | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 951 E MARKET STREET | ||||||||
| Address2: | |||||||||
| City: | CADIZ | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7409424631 | ||||||||
| FaxNumber: | 7409426301 | ||||||||
| Practice Location | |||||||||
| Address1: | 951 E MARKET STREET | ||||||||
| Address2: | |||||||||
| City: | CADIZ | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7409424631 | ||||||||
| FaxNumber: | 7409426301 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2006 | ||||||||
| LastUpdateDate: | 07/21/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 02490 | WV | Y | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 35.122537 | OH | N | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 2984623 | 05 | OH | MEDICAID | 3810026536 | 05 | WV | MEDICAID | 101442860 | 05 | PA | MEDICAID |