Provider Demographics
NPI:1689654352
Name:GINELLA, MICHAEL J (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:GINELLA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3428 W MARKET ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3339
Mailing Address - Country:US
Mailing Address - Phone:330-344-3583
Mailing Address - Fax:330-869-2074
Practice Address - Street 1:1587 BOETTLER RD
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-7823
Practice Address - Country:US
Practice Address - Phone:330-896-3447
Practice Address - Fax:330-896-9919
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2008-05-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH34-00-6369207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2229412Medicaid
OH1232120011OtherMEDICARE DME
OH1467490961OtherNPI GROUP NUMBER
OH9338635OtherMEDICARE GROUP NUMBER
OH2229412Medicaid
H06184Medicare UPIN