Healthcare Provider Details

I. General information

NPI: 1144682295
Provider Name (Legal Business Name): JASON CHRISTOPHER PRADARELLI MD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2016
Last Update Date: 05/08/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 E APPLE ST STE 6258
DAYTON OH
45409-2939
US

IV. Provider business mailing address

30 E APPLE ST STE 6258
DAYTON OH
45409-2939
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-8000
  • Fax:
Mailing address:
  • Phone: 937-208-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number268000
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number275021
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number57.258999
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: