Provider Demographics
NPI:1902400245
Name:MOSCARELLO, DOMINIC JOESPH
Entity Type:Individual
Prefix:
First Name:DOMINIC
Middle Name:JOESPH
Last Name:MOSCARELLO
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 1:3545 DOTWOOD ST NW
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-4451
Mailing Address - Country:US
Mailing Address - Phone:330-587-8959
Mailing Address - Fax:
Practice Address - Street 1:3545 DOTWOOD ST NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-4451
Practice Address - Country:US
Practice Address - Phone:330-587-8959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-27
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker