DR. THEODORE A BUCCILLI JR. (NPI# 1164413019) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164413019 |
| Entity Type | Individual |
| Full Name | DR. THEODORE A BUCCILLI JR. |
| Credential | DPM |
| Practice Address |
4403 Clover Dr Ravenna OH 44266-8636 |
| Mailing Address |
25 S Main St Ste 7 Munroe Falls OH 44262-1660 |
| Practice Telephone | 3306877464 |
| Mailing Telephone | 2347062395 |
| Mailing Fax Number | 2346788222 |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2019-03-01 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 213E00000X | Podiatrist | 36003352 | OH | Podiatric Medicine & Surgery Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | 2538178 | 05 |
| Street Address |
4403 CLOVER DR |
| City | RAVENNA |
| State | OH |
| Zip Code | 44266-8636 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639235351 | Northeastern Ohio Foot & Ankle Surgical Associates, Inc. | Podiatrist | 4403 Clover Dr, Ravenna, OH 44266-8636 | 2006-12-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407409501 | Jeffrey Michael Jones | Hearing Instrument Specialist | 131 E. Hain St Beltone Hearing Care Center, Ravenna, OH 44266 | 2019-07-18 |
| 1285286443 | Robert Ailes Lax | Counselor | 246 S. Chestnut St., Ravenna, OH 44266 | 2019-07-09 |
| 1841792314 | Jason Troyer | Case Manager/Care Coordinator | 3920 Lover's Lane, Ravenna, OH 44266 | 2018-03-01 |
| 1316446370 | Jacquelin Grace Claren | Case Manager/Care Coordinator | 3920 Lovers Lane, Ravenna, OH 44266 | 2018-02-06 |
| 1164921318 | Tammy M Morris | Counselor | 4771 Washington Ave., Ravenna, OH 44266 | 2018-02-02 |
| 1306360219 | Megan Kathryn Marsh | Nurse Practitioner | 3215 Menough Rd, Ravenna, OH 44266 | 2017-08-01 |
| 1063875110 | Mary Kathryn Revello | Home Health Aide | 103 N.scycamore St, Ravenna 44266, OH 44266 | 2016-04-05 |
| 1396114302 | Theresa Brooks Kotlar | Registered Nurse | 7174 Colonial Place, Ravenna, OH 44266 | 2015-09-20 |
| 1811384118 | Okap Kwon Md Inc | Internal Medicine | 964 East Main Street, Ravenna, OH 44266 | 2015-04-24 |
| 1104223783 | Julie Winkler | Speech-Language Pathologist | 639 W. Main St, Ravenna, OH 44266 | 2014-11-26 |
| Find all providers in zip 44266 | ||||
| Taxonomy Code | 213E00000X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| A podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical and other operative procedures, prescribe corrective devices and prescribe and administer drugs and physical therapy. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114140977 | Portage Foot Health, Inc. | Podiatrist | 444 S Meridian St, Ste 7, Ravenna, OH 44266-2961 | 2007-04-10 |
| 1013979970 | Eric J Paul | Podiatrist | 6693 North Chestnut St, Ste 12-b, Ravenna, OH 44266 | 2006-04-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013518950 | Mobile Foot Care Specialists, L.L.C. | Podiatrist | 38752 Renwood Ave, Avon, OH 44011-5229 | 2020-11-06 |
| 1275159345 | Buckeye Foot Care | Podiatrist | 5105 Som Center Rd Ste 102, Willoughby, OH 44094-4203 | 2020-06-24 |
| 1285289439 | Brent L. Rubin & Associates Inc | Podiatrist | 755 W South Boundary St, Perrysburg, OH 43551-5226 | 2019-08-05 |
| 1902467459 | Zaccardelli and Ritz | Podiatrist | 5556 Ridge Rd, Parma, OH 44129-2305 | 2019-06-25 |
| 1134786635 | Integrity Foot and Ankle Associates, LLC | Podiatrist | 1740 Cooper Foster Park Rd W Ste B, Lorain, OH 44053-4201 | 2019-05-21 |
| 1891351185 | Foot and Ankle Specialists of Central Ohio LLC | Podiatrist | 1 Healthy Place, Suite 202, Pataskala, OH 43062-7067 | 2019-05-13 |
| 1376109660 | Foot and Ankle Specialists of Central Ohio LLC | Podiatrist | 65 E Granville St, Sunbury, OH 43074-9130 | 2019-05-13 |
| 1770149296 | Foot and Ankle Specialists of Central Ohio, LLC | Podiatrist | 6002 E. Main Street, Columbus, OH 43213-3355 | 2019-05-10 |
| 1295390268 | Greenberg Foot and Ankle | Podiatrist | 1989 Miamisburg Centerville Rd Ste 200, Dayton, OH 45459-3858 | 2019-05-06 |
| 1083278287 | Kburtondpm LLC | Podiatrist | 662 Seagull Ct, Westerville, OH 43082-8534 | 2019-04-24 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.