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General NPI Number Information
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NPI Number | 1821040064
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Entity Type | Individual
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Provider Name | ERNEST A DECHELLIS D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 07/28/2016
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Provider Practice Location Address
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Address Line | 3002 B ELMVIEW PROF PK STATE RT 5
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City | CORTLAND
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State | OH
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Zip | 44410-9202
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Country | US
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Telephone | 330-637-1000
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Fax | 330-637-9905
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Provider Business Mailing Address
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Address Line | 3002 STATE ROUTE 5 STE B
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City | CORTLAND
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State | OH
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Zip | 44410-9202
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Country | US
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Telephone | 330-637-1000
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Fax | 330-637-9905
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 34004006
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License Number State | OH
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