Healthcare Provider Details

I. General information

NPI: 1205866654
Provider Name (Legal Business Name): JOHN A MOAWAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 04/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 ARCH ST SUITE 215
AKRON OH
44304-1467
US

IV. Provider business mailing address

95 ARCH ST SUITE 215
AKRON OH
44304-1467
US

V. Phone/Fax

Practice location:
  • Phone: 330-434-4145
  • Fax:
Mailing address:
  • Phone: 330-434-4145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number35079902
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number3609197
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: