Provider Demographics
NPI:1497710933
Name:OCCHIONERO, SCOT J (MD)
Entity Type:Individual
Prefix:
First Name:SCOT
Middle Name:J
Last Name:OCCHIONERO
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 8792
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-8792
Mailing Address - Country:US
Mailing Address - Phone:440-871-5100
Mailing Address - Fax:440-871-5610
Practice Address - Street 1:2001 CROCKER RD STE 600
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-6972
Practice Address - Country:US
Practice Address - Phone:440-871-5100
Practice Address - Fax:440-871-5610
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35054233208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0742923Medicaid
OHOC0667242Medicare ID - Type Unspecified
OHE65479Medicare UPIN