Provider Demographics
NPI:1588779748
Name:GIVEN, JOHN THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:THOMAS
Last Name:GIVEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4048 DRESSLER RD NW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2784
Mailing Address - Country:US
Mailing Address - Phone:330-479-3333
Mailing Address - Fax:330-479-3334
Practice Address - Street 1:4048 DRESSLER RD NW
Practice Address - Street 2:SUITE 100
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2784
Practice Address - Country:US
Practice Address - Phone:330-479-3333
Practice Address - Fax:330-479-3334
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35050329207RP1001X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0264922Medicaid
OH0563439Medicaid
OHJO9332571Medicare PIN
OHC03768Medicare UPIN
OH0563439Medicaid