Provider Demographics
NPI:1194717454
Name:ANDREOZZI, JOHN CHARLES (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CHARLES
Last Name:ANDREOZZI
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 1:3325 SUMSER ST NW
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-7954
Mailing Address - Country:US
Mailing Address - Phone:330-499-7219
Mailing Address - Fax:330-588-2216
Practice Address - Street 1:2600 SIXTH ST SW FL 6
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44710-1702
Practice Address - Country:US
Practice Address - Phone:308-303-3933
Practice Address - Fax:234-521-7091
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350383422084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0447396Medicaid
OH010057157OtherRAILROAD MEDICARE
OH000000132772OtherANTHEM BCBS
OH0447396Medicaid
OH000000132772OtherANTHEM BCBS
OH0503303Medicare PIN
OH000000132772OtherUNICARE-LIFE&HEALTH
OH0447396Medicaid