Basic Information
| Provider Information | |||||||||
| NPI: | 1669712568 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | D'AMICO | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | DVM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7477 TOWNSHIP LINE RD | ||||||||
| Address2: | |||||||||
| City: | WAYNESVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450688051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138976991 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7477 TOWNSHIP LINE RD | ||||||||
| Address2: | |||||||||
| City: | WAYNESVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450688051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138976991 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2013 | ||||||||
| LastUpdateDate: | 03/01/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174M00000X | VET . 4477 | OH | Y | Other Service Providers | Veterinarian |
ID Information
| ID | Type | State | Issuer | Description | VET . 4477 | 01 | OH | VETERINARY MEDICAL LICENSE | OTHER |