Provider Demographics
NPI:1003479858
Name:CACCIOTTI, MARIA KRISTINE (DO)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:KRISTINE
Last Name:CACCIOTTI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 VILLAGE SQUARE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-1762
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1103 VILLAGE SQUARE DR STE 101
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-1762
Practice Address - Country:US
Practice Address - Phone:419-872-3207
Practice Address - Fax:419-872-3237
Is Sole Proprietor?:No
Enumeration Date:2019-04-17
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34016557207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology