Provider Demographics
NPI:1477551349
Name:SEVACHKO, GERALD S (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:S
Last Name:SEVACHKO
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 1:8135 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-6244
Mailing Address - Country:US
Mailing Address - Phone:330-758-0900
Mailing Address - Fax:330-758-2790
Practice Address - Street 1:8135 MARKET ST
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-6244
Practice Address - Country:US
Practice Address - Phone:330-758-0900
Practice Address - Fax:330-758-2790
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2014-07-01
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-23
Provider Licenses
StateLicense IDTaxonomies
OH35031136207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0154309Medicaid
OH0154309Medicaid
OHSE0149462Medicare ID - Type Unspecified