Basic Information
| Provider Information | |||||||||
| NPI: | 1427168459 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TRIZZINO | ||||||||
| FirstName: | DONALD | ||||||||
| MiddleName: | F | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | BCHIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 617 WABASH AVE NW | ||||||||
| Address2: | |||||||||
| City: | NEW PHILADELPHIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446634145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303646637 | ||||||||
| FaxNumber: | 3303644343 | ||||||||
| Practice Location | |||||||||
| Address1: | 617 WABASH AVE NW | ||||||||
| Address2: | |||||||||
| City: | NEW PHILADELPHIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446634145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303646637 | ||||||||
| FaxNumber: | 3303644343 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | 587 | OH | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
ID Information
| ID | Type | State | Issuer | Description | 341269742002 | 01 | OH | MEDICAL MUTUAL | OTHER | 0448797 | 05 | OH | MEDICAID | 000000155467 | 01 | OH | ANTHEM BCBS | OTHER |