Provider Demographics
NPI:1851334072
Name:DESAPRI, JAMES W
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:W
Last Name:DESAPRI
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 1:1272 W MAIN ST STE 503
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-2058
Mailing Address - Country:US
Mailing Address - Phone:220-564-1788
Mailing Address - Fax:220-564-1789
Practice Address - Street 1:1272 W MAIN ST STE 503
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-2058
Practice Address - Country:US
Practice Address - Phone:220-564-1788
Practice Address - Fax:220-564-1789
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007998207Q00000X
OH34-00-7988-D207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2420106Medicaid
OH2420106Medicaid