1144271941 NPI number — DR. R DOUGLAS TROCHELMAN M.D.

Table of content: DR. R DOUGLAS TROCHELMAN M.D. (NPI 1144271941)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144271941 NPI number — DR. R DOUGLAS TROCHELMAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TROCHELMAN
Provider First Name:
R
Provider Middle Name:
DOUGLAS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1144271941
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
161 N FORGE ST
Provider Second Line Business Mailing Address:
STE. 198
Provider Business Mailing Address City Name:
AKRON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44304-1468
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-376-1043
Provider Business Mailing Address Fax Number:
330-376-9951

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
161 N FORGE ST
Provider Second Line Business Practice Location Address:
STE. 198
Provider Business Practice Location Address City Name:
AKRON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44304-1468
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-376-1043
Provider Business Practice Location Address Fax Number:
330-376-9951
Provider Enumeration Date:
05/15/2006

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: 207RX0202X , with the licence number:  35049857 , 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: 300583337001 . This is a "MMOH" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0617153 . This is a "MEDICARE ID" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0705044 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 341587155B . This is a "ACHS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000134682 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 110029259 . This is a "RR MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 793693 . This is a "UHC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: TRO617151 . This is a "MEDICARE ID" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 7328574 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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