Provider Demographics
NPI:1114115581
Name:RUCKER, CHRISTOPHER LOUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:LOUIS
Last Name:RUCKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3515 MASSILLON RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-6400
Mailing Address - Country:US
Mailing Address - Phone:330-899-9350
Mailing Address - Fax:330-634-1329
Practice Address - Street 1:3300 GREENWICH RD
Practice Address - Street 2:STE 8
Practice Address - City:NORTON
Practice Address - State:OH
Practice Address - Zip Code:44203-5780
Practice Address - Country:US
Practice Address - Phone:330-825-7371
Practice Address - Fax:330-825-7482
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-092406207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2949706Medicaid
OHRU4245891Medicare PIN