Provider Demographics
NPI:1801867874
Name:SAMMARCO, GIACOMO JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:GIACOMO
Middle Name:JAMES
Last Name:SAMMARCO
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 1:10663 MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4469
Mailing Address - Country:US
Mailing Address - Phone:513-794-8465
Mailing Address - Fax:
Practice Address - Street 1:311 STRAIGHT ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-1018
Practice Address - Country:US
Practice Address - Phone:513-559-2122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-030674207XX0005X
LAL009935207XX0005X
NJMA21035207XX0005X
NY134480207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSA0368783Medicare PIN
C00921Medicare UPIN