1972978690 NPI number — JULIA LAROCCA NP

Table of content: JULIA LAROCCA NP (NPI 1972978690)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972978690 NPI number — JULIA LAROCCA NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAROCCA
Provider First Name:
JULIA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PETERSON
Provider Other First Name:
JULIA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1972978690
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/24/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
284 OWOSSO AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRLAWN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44333-3743
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 AKRON GENERAL AVE
Provider Second Line Business Practice Location Address:
5TH FLOOR, ACC
Provider Business Practice Location Address City Name:
AKRON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44307-2432
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-344-6015
Provider Business Practice Location Address Fax Number:
330-344-6820
Provider Enumeration Date:
12/07/2015

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: 363L00000X , with the licence number:  COA.18384-NP , 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: 0454744 . This is a "AKRON GENERAL MEDICAL CENTER MEDICAID GROUP # (IMCA)" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0152618 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9338635 . This is a "PARTNERS PHYSICIAN GROUP MEDICARE GROUP #" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1841239274 . This is a "PARTNERS PHYSICIAN GROUP TYPE 2 NPI #" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 3600271 . This is a "AKRON GENERAL MEDICAL CENTER MEDICARE GROUP # (IMCA)" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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