Provider Demographics
NPI:1720406994
Name:RICHARD D. SBROCCHI MD FACS INC
Entity Type:Organization
Organization Name:RICHARD D. SBROCCHI MD FACS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:SBROCCHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-517-7575
Mailing Address - Street 1:7640 SYLVANIA AVE
Mailing Address - Street 2:SUITE N
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-9729
Mailing Address - Country:US
Mailing Address - Phone:419-824-5063
Mailing Address - Fax:419-824-0216
Practice Address - Street 1:7640 SYLVANIA AVE
Practice Address - Street 2:SUITE N
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-9729
Practice Address - Country:US
Practice Address - Phone:419-824-5063
Practice Address - Fax:419-824-0216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-03
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350528782086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty