Provider Demographics
NPI:1922339308
Name:CHICORELLI, ANNE MARIE (DO)
Entity Type:Individual
Prefix:
First Name:ANNE MARIE
Middle Name:
Last Name:CHICORELLI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPT 781584
Mailing Address - Street 2:PO BOX 78000
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1584
Mailing Address - Country:US
Mailing Address - Phone:330-263-8428
Mailing Address - Fax:330-263-8190
Practice Address - Street 1:3727 FRIENDSVILLE RD
Practice Address - Street 2:SUITE 5
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-7131
Practice Address - Country:US
Practice Address - Phone:330-263-8428
Practice Address - Fax:330-263-8190
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-25
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA244718207X00000X
PAOS013876207X00000X
OH34010345207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0066850Medicaid
OH0066850Medicaid