1508863630 NPI number — JOHN CHIARO DPM

Table of content: JOHN CHIARO DPM (NPI 1508863630)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508863630 NPI number — JOHN CHIARO DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHIARO
Provider First Name:
JOHN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1508863630
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/21/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 378
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANDUSKY
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44871-0378
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-626-6161
Provider Business Mailing Address Fax Number:
419-502-3511

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3262 CENTER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POLAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44514-2201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-707-1220
Provider Business Practice Location Address Fax Number:
330-707-1066
Provider Enumeration Date:
07/05/2005

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: 213E00000X , with the licence number:  SC-00-3881 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213E00000X , with the licence number: 36-00-2826 , 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: 6420087-000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0968510 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01442633 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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