Provider Demographics
NPI:1346207453
Name:LEMMO, JOHN J (PAC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:LEMMO
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 RIVER VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-1659
Mailing Address - Country:US
Mailing Address - Phone:740-687-2273
Mailing Address - Fax:740-687-9059
Practice Address - Street 1:1201 RIVER VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-1659
Practice Address - Country:US
Practice Address - Phone:740-687-2273
Practice Address - Fax:740-687-9059
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50000238363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH201307080OtherTAX ID NUMBER
S52515Medicare UPIN
LEPA10858Medicare PIN