Healthcare Provider Details

I. General information

NPI: 1003923335
Provider Name (Legal Business Name): JOHN S. BUCCHIERI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 MENTOR AVE SUITE 210
MENTOR OH
44060-8713
US

IV. Provider business mailing address

9500 MENTOR AVE SUITE 210
MENTOR OH
44060-8713
US

V. Phone/Fax

Practice location:
  • Phone: 440-352-1711
  • Fax: 440-352-7562
Mailing address:
  • Phone: 440-352-1711
  • Fax: 440-352-7562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number35-07-8008-B
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number35-07-8008-B
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: