Provider Demographics
NPI:1821040064
Name:DECHELLIS, ERNEST A (DO)
Entity Type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:A
Last Name:DECHELLIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:3002 STATE ROUTE 5
Mailing Address - Street 2:STE B
Mailing Address - City:CORTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44410-9202
Mailing Address - Country:US
Mailing Address - Phone:330-637-1000
Mailing Address - Fax:330-637-9905
Practice Address - Street 1:3002 B ELMVIEW PROF PK
Practice Address - Street 2:STATE RT 5
Practice Address - City:CORTLAND
Practice Address - State:OH
Practice Address - Zip Code:44410-9202
Practice Address - Country:US
Practice Address - Phone:330-637-1000
Practice Address - Fax:330-637-9905
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2016-07-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH34004006207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHA16711Medicare UPIN