Provider Demographics
NPI:1063414456
Name:SPACCARELLI, JOHN F (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:F
Last Name:SPACCARELLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7109 BACHMAN RD
Mailing Address - Street 2:
Mailing Address - City:SARDINIA
Mailing Address - State:OH
Mailing Address - Zip Code:45171-8242
Mailing Address - Country:US
Mailing Address - Phone:937-446-2531
Mailing Address - Fax:937-446-3441
Practice Address - Street 1:7109 BACHMAN RD
Practice Address - Street 2:
Practice Address - City:SARDINIA
Practice Address - State:OH
Practice Address - Zip Code:45171-8242
Practice Address - Country:US
Practice Address - Phone:937-446-2531
Practice Address - Fax:937-446-3441
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35040550207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0397155Medicaid
OHP00034375OtherMEDICARE RR
OH0441245Medicare PIN
OHP00034375OtherMEDICARE RR