Provider Demographics
NPI:1508863630
Name:CHIARO, JOHN (DPM)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:CHIARO
Suffix:
Gender:M
Credentials:DPM
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 378
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44871-0378
Mailing Address - Country:US
Mailing Address - Phone:419-626-6161
Mailing Address - Fax:419-502-3511
Practice Address - Street 1:3262 CENTER RD
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-2201
Practice Address - Country:US
Practice Address - Phone:330-707-1220
Practice Address - Fax:330-707-1066
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC-00-3881213E00000X
OH36-00-2826213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV6420087-000Medicaid
OH0968510Medicaid
PA01442633Medicaid
4011765Medicare ID - Type Unspecified
0868823Medicare ID - Type Unspecified
4011764Medicare ID - Type Unspecified
0868827Medicare ID - Type Unspecified
0868829Medicare ID - Type Unspecified
4011767Medicare ID - Type Unspecified
4011768Medicare ID - Type Unspecified
4011762Medicare ID - Type Unspecified
4011763Medicare ID - Type Unspecified
OH0868822Medicare ID - Type Unspecified
0868825Medicare ID - Type Unspecified
4011761Medicare ID - Type Unspecified
OH0968510Medicaid
4143391Medicare ID - Type Unspecified
0868828Medicare ID - Type Unspecified
PA01442633Medicaid