Healthcare Provider Details

I. General information

NPI: 1407032865
Provider Name (Legal Business Name): LOUISA LUCIA PECCHIONI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2008
Last Update Date: 10/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE ELIZABETH PLACE SUITE 10A
DAYTON OH
45417
US

IV. Provider business mailing address

ONE ELIZABETH PLACE SUITE 10A
DAYTON OH
45417
US

V. Phone/Fax

Practice location:
  • Phone: 937-228-4126
  • Fax: 937-228-0247
Mailing address:
  • Phone: 937-228-4126
  • Fax: 937-228-0247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number35.086267
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: