1669474649 NPI number — BRIAN J CECCARELLI D. O.

Table of content: BRIAN J CECCARELLI D. O. (NPI 1669474649)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669474649 NPI number — BRIAN J CECCARELLI D. O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CECCARELLI
Provider First Name:
BRIAN
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D. O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669474649
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 713130
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45271-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-415-9100
Provider Business Mailing Address Fax Number:
937-415-9191

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4160 LITTLE YORK RD
Provider Second Line Business Practice Location Address:
STE. 10
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45414-5800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-415-9100
Provider Business Practice Location Address Fax Number:
937-415-9191
Provider Enumeration Date:
08/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  3891 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0739008 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00657291 . This is a "RR MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 200021341 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com