1215009709

Everything you always wanted to know about PANTANGCO P IRINEO JR. MD/MBA 5 PANTANGCO P IRINEO JR. MD/MBA but were afraid to ask.

PANTANGCO P IRINEO JR. MD/MBA 5 PANTANGCO P IRINEO JR. MD/MBA

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Provider Last Name Provider Middle Name Provider First Name Provider Suffix Provider Credential Provider Other Name Type Code Provider Other Last Name Provider Other Middle Name Provider Other First Name Provider Other Name Suffix Provider Other Credential
PANTANGCO P IRINEO JR. MD/MBA 5 PANTANGCO P IRINEO JR. MD/MBA
Gender:
Male
Enumeration date:
2006-11-14
Last update date:
2013-02-19
Current as of:
Is sole proprietor?:
No
Is organization subpart?:
No
In PECOS?:
Yes
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Identifiers

identifier description issuer state
0414035 Medicare ID-Type Undpecified none OH
0281985 Medicaid none OH

Taxonomies

Taxonomy State License Number Primary?
207XX0005X Sports Medicine OH 35100324

Phone Numbers

Type Number
Mailing Address Telephone Number 6147179722
Practice Location Address Telephone Number 6147179722
Mailing Address Fax Number 6147179722
Practice Location Address Fax Number 6147179722

Addresses

Type Address City State Postal Country
Mailing Address 5857 DYRHAM PARK DUBLIN OH 43017 OH
Practice Location Address 5857 DYRHAM PARK DUBLIN OH 43017 OH