Provider Demographics
NPI:1891780599
Name:CHUBA, VERN MICHAEL (DPM)
Entity type:Individual
Prefix:DR
First Name:VERN
Middle Name:MICHAEL
Last Name:CHUBA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 N HERMITAGE RD
Mailing Address - Street 2:STE 3
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-3373
Mailing Address - Country:US
Mailing Address - Phone:330-759-7920
Mailing Address - Fax:
Practice Address - Street 1:819 MCCARTNEY RD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-5047
Practice Address - Country:US
Practice Address - Phone:330-746-7660
Practice Address - Fax:330-746-8581
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003111-C213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2262304Medicaid
OH000000236058OtherANTHEMBCBS
OHU84671Medicare UPIN
OH4047304Medicare PIN
OH4047303Medicare PIN