Provider Demographics
NPI:1801928122
Name:BELL, JOHN W II (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:BELL
Suffix:II
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 1:3745 GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44055-2734
Mailing Address - Country:US
Mailing Address - Phone:440-240-2121
Mailing Address - Fax:440-233-0194
Practice Address - Street 1:3745 GROVE AVE
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44055-2734
Practice Address - Country:US
Practice Address - Phone:440-240-1655
Practice Address - Fax:440-233-0194
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35 . 026591174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0111453Medicaid
OH0111453Medicaid