Provider Demographics
NPI:1003923335
Name:BUCCHIERI, JOHN S (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:S
Last Name:BUCCHIERI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 MENTOR AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-8713
Mailing Address - Country:US
Mailing Address - Phone:440-352-1711
Mailing Address - Fax:440-352-7562
Practice Address - Street 1:9500 MENTOR AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-8713
Practice Address - Country:US
Practice Address - Phone:440-352-1711
Practice Address - Fax:440-352-7562
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-07-8008-B207XS0106X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2185648Medicaid
OHBU4019732Medicare ID - Type UnspecifiedMEDICARE #
OH2185648Medicaid