Provider Demographics
NPI:1013945443
Name:CECCHINO, ROBERT A (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:CECCHINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:ANDREW
Other - Last Name:CECCHINO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:27 ST LAWRENCE DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-8312
Mailing Address - Country:US
Mailing Address - Phone:419-455-8560
Mailing Address - Fax:419-455-8564
Practice Address - Street 1:27 ST LAWRENCE DR
Practice Address - Street 2:SUITE 203
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-8312
Practice Address - Country:US
Practice Address - Phone:419-455-8560
Practice Address - Fax:419-455-8564
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35036074C208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000341388OtherANTHEM
IN200339770Medicaid
OH000000341388OtherANTHEM
OH0390063Medicaid
OHWA3600441Medicare Oscar/Certification
OH4197271Medicare ID - Type Unspecified
OH0390063Medicaid
OHP00352665Medicare ID - Type UnspecifiedRAILROAD