Provider Demographics
NPI:1710144126
Name:LAMACCHIA, MARC ANDREW
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:ANDREW
Last Name:LAMACCHIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4450 BELDEN VILLAGE ST NW STE 307
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2592
Mailing Address - Country:US
Mailing Address - Phone:440-226-2596
Mailing Address - Fax:440-579-0167
Practice Address - Street 1:15345 BAGLEY RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44130-4825
Practice Address - Country:US
Practice Address - Phone:440-743-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH67.000144367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3017354Medicaid