Provider Demographics
NPI:1184617300
Name:SAMMARONE, CHARLES PATRICK JR (DO)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:PATRICK
Last Name:SAMMARONE
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HUBBARD
Mailing Address - State:OH
Mailing Address - Zip Code:44425-1126
Mailing Address - Country:US
Mailing Address - Phone:330-534-1959
Mailing Address - Fax:330-534-2206
Practice Address - Street 1:730 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HUBBARD
Practice Address - State:OH
Practice Address - Zip Code:44425-1126
Practice Address - Country:US
Practice Address - Phone:330-534-1959
Practice Address - Fax:330-534-2206
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-6563207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2075516Medicaid
G80028Medicare UPIN
OH0856351Medicare PIN