Provider Demographics
NPI:1487656195
Name:VALADE, JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:VALADE
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 1:7640 SYLVANIA AVE
Mailing Address - Street 2:D1
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-9729
Mailing Address - Country:US
Mailing Address - Phone:419-841-4099
Mailing Address - Fax:419-841-8125
Practice Address - Street 1:7640 SYLVANIA AVE
Practice Address - Street 2:D1
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-9729
Practice Address - Country:US
Practice Address - Phone:419-841-4099
Practice Address - Fax:419-841-8125
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35061332207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2757977Medicaid
00000051547OtherANTHEM
OH01357OtherPARAMOUNT
P00403187OtherRRMED
OH2757977Medicaid
P00403187OtherRRMED