Provider Demographics
NPI:1013970151
Name:MERANDA, JOHN R (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:MERANDA
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 1:167 W MAIN RD STE G
Mailing Address - Street 2:
Mailing Address - City:CONNEAUT
Mailing Address - State:OH
Mailing Address - Zip Code:44030-2057
Mailing Address - Country:US
Mailing Address - Phone:440-599-8844
Mailing Address - Fax:440-593-6014
Practice Address - Street 1:167 W MAIN RD STE G
Practice Address - Street 2:
Practice Address - City:CONNEAUT
Practice Address - State:OH
Practice Address - Zip Code:44030-2057
Practice Address - Country:US
Practice Address - Phone:440-599-8844
Practice Address - Fax:440-593-6014
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35049707207P00000X
OH35-49707207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHN420333OtherWELLCARE
OH0674533Medicaid
OHME0615564OtherMEDICARE
OHP00066338OtherRR MEDICARE
OH000000301814OtherANTHEM
OHP00066338Medicare PIN
OH000000301814OtherANTHEM
OHME0615564OtherMEDICARE
OHN420333OtherWELLCARE