Healthcare Provider Details

I. General information

NPI: 1962501056
Provider Name (Legal Business Name): SYCAMORE MEDICAL ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 10/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 N PENNINGTON ST
SYCAMORE OH
44882-9408
US

IV. Provider business mailing address

103 N PENNINGTON ST
SYCAMORE OH
44882-9408
US

V. Phone/Fax

Practice location:
  • Phone: 419-927-6552
  • Fax: 419-927-6500
Mailing address:
  • Phone: 419-927-6552
  • Fax: 419-927-6500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateOH

VIII. Authorized Official

Name: N SCOTT CISAR
Title or Position: PRESIDENT
Credential: M.D.
Phone: 419-927-6552