Provider Demographics
NPI:1881673523
Name:OCHOA, FABIO V (MD)
Entity Type:Individual
Prefix:MR
First Name:FABIO
Middle Name:V
Last Name:OCHOA
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 1:1716 NORTH RD SE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-2907
Mailing Address - Country:US
Mailing Address - Phone:330-399-9776
Mailing Address - Fax:330-399-8665
Practice Address - Street 1:1716 NORTH RD SE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-2907
Practice Address - Country:US
Practice Address - Phone:330-399-9776
Practice Address - Fax:330-399-8665
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-03-4629207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0199584Medicaid
OH0376495Medicare ID - Type UnspecifiedPROVIDER NUMBER
OHA74194Medicare UPIN