Healthcare Provider Details

I. General information

NPI: 1053388892
Provider Name (Legal Business Name): ROBERT DANIEL CEVASCO JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 06/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 ARCH ST STE G2
AKRON OH
44304-1429
US

IV. Provider business mailing address

168 E MARKET ST PO BOX 3542
AKRON OH
44308-2038
US

V. Phone/Fax

Practice location:
  • Phone: 330-375-4100
  • Fax: 330-375-4097
Mailing address:
  • Phone: 330-996-0347
  • Fax: 330-996-0359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number35043548
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: