Provider Demographics
NPI:1083900252
Name:GUMUCIO, DAVID A (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:GUMUCIO
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:26908 DETROIT RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-2398
Mailing Address - Country:US
Mailing Address - Phone:440-250-8660
Mailing Address - Fax:440-250-8639
Practice Address - Street 1:19800 DETROIT RD
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-1816
Practice Address - Country:US
Practice Address - Phone:440-333-1107
Practice Address - Fax:440-333-1064
Is Sole Proprietor?:No
Enumeration Date:2011-06-25
Last Update Date:2020-11-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH34010802207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0105599Medicaid
OH336230Medicare PIN