Provider Demographics
NPI:1013975077
Name:VISCOMI, JEFFREY J (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:J
Last Name:VISCOMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:10633 PEARL RD
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44136-1435
Mailing Address - Country:US
Mailing Address - Phone:440-846-6963
Mailing Address - Fax:440-846-0011
Practice Address - Street 1:10633 PEARL RD
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136-1435
Practice Address - Country:US
Practice Address - Phone:440-846-6963
Practice Address - Fax:440-846-0011
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH201249527207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0108949Medicaid
OH0108949Medicaid
OHF96477Medicare UPIN