MEDICARE: DR. JOHN R MERANDA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	35049707	OH
2	207Q00000X	Family Medicine Physician	35-49707	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	ME0615564	OTHER	OH	MEDICARE
4	P00066338	OTHER	OH	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	N420333	OTHER	OH	WELLCARE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	000000301814	OTHER	OH	ANTHEM

General Provider Information

NPI Number	:	1013970151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN R MERANDA MD

Provider Business Mailing Address
First Line	:	167 W MAIN RD STE G
Second Line	:
City	:	CONNEAUT
State	:	OH
Zip	:	44030-2057
Country	:	US
Telephone Number	:	440-599-8844
Fax Number	:	440-593-6014

Provider Business Practice Location Address
First Line	:	167 W MAIN RD STE G
Second Line	:
City	:	CONNEAUT
State	:	OH
Zip	:	44030-2057
Country	:	US
Telephone Number	:	440-599-8844
Fax Number	:	440-593-6014

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	02/27/2012

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Directions to “ DR. JOHN R MERANDA MD” Practice Location

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