Healthcare Provider Details

I. General information

NPI: 1184761405
Provider Name (Legal Business Name): COMMUNITY MEDICAL ASSOCIATES, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 04/28/2023
Certification Date: 04/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 S CANFIELD NILES RD
YOUNGSTOWN OH
44515
US

IV. Provider business mailing address

1450 S CANFIELD NILES RD
YOUNGSTOWN OH
44515
US

V. Phone/Fax

Practice location:
  • Phone: 330-799-8752
  • Fax: 330-799-8754
Mailing address:
  • Phone: 330-799-8752
  • Fax: 330-799-8754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateOH

VIII. Authorized Official

Name: DANIEL A. MILLER
Title or Position: OWNER/PRACTICE MANAGER
Credential: M.D.
Phone: 330-799-8752