Provider Demographics
NPI:1174552251
Name:GIANNATTASIO, BARTOLOMEO (MD)
Entity type:Individual
Prefix:
First Name:BARTOLOMEO
Middle Name:
Last Name:GIANNATTASIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7255 OLD OAK BLVD
Mailing Address - Street 2:C208
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3329
Mailing Address - Country:US
Mailing Address - Phone:440-816-2708
Mailing Address - Fax:440-243-8480
Practice Address - Street 1:7255 OLD OAK BLVD
Practice Address - Street 2:C208
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3329
Practice Address - Country:US
Practice Address - Phone:440-816-2708
Practice Address - Fax:440-243-8480
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35075324207RC0000X, 207RC0001X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH341487428OtherTAX ID
OH2190392Medicaid
OHP75324OtherSUMMACARE
OH106855OtherKAISER
OH7775149OtherAETNA
OH000000355013OtherANTHEM BLUE CROSS/BLUE SH
OH91378OtherQUALCHOICE
OHP00203912OtherRAILROAD MEDICARE
OH2190392Medicaid
OH341487428OtherTAX ID
OH4020763Medicare ID - Type Unspecified