Provider Demographics
NPI:1467485698
Name:ZUCCARELLO, MARIO (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:
Last Name:ZUCCARELLO
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:PO BOX 643398
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45264-3398
Mailing Address - Country:US
Mailing Address - Phone:513-221-1100
Mailing Address - Fax:513-569-5297
Practice Address - Street 1:3825 EDWARDS RD STE 300
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45209-1288
Practice Address - Country:US
Practice Address - Phone:513-221-1100
Practice Address - Fax:513-569-5297
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35059555207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9298734Medicaid
OHF79377Medicare UPIN
OH9298734Medicaid