Healthcare Provider Details

I. General information

NPI: 1417016973
Provider Name (Legal Business Name): OHIO PHYSICIAN PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 09/02/2025
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 SIXTH ST SW
CANTON OH
44710-1702
US

IV. Provider business mailing address

PO BOX 80690
CANTON OH
44708-0690
US

V. Phone/Fax

Practice location:
  • Phone: 330-479-8705
  • Fax:
Mailing address:
  • Phone: 330-479-8705
  • Fax: 330-479-9330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW STEWART
Title or Position: PRESIDENT
Credential:
Phone: 330-363-4472