Provider Demographics
NPI:1902999170
Name:CHECCONE, ALBERT G (DO)
Entity type:Individual
Prefix:
First Name:ALBERT
Middle Name:G
Last Name:CHECCONE
Suffix:
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 1:3605 WARRENSVILLE CENTER ROAD
Mailing Address - Street 2:MSC 9152
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122
Mailing Address - Country:US
Mailing Address - Phone:216-286-6299
Mailing Address - Fax:216-286-6341
Practice Address - Street 1:11100 EUCLID AVENUE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106
Practice Address - Country:US
Practice Address - Phone:330-533-6820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH18142085U0001X
OH34 0018142085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000225195OtherUNSION
OH0420351Medicaid
OH4292126OtherAETNA
OH000000537151OtherANTHEM
OHP00435011OtherRAILROAD MEDICARE
OH0304914OtherBCMH
OH404216OtherWELLCARE
OH751120OtherBUCKEYE
OHCH0436345Medicare PIN
OH404216OtherWELLCARE
OH9913962Medicare ID - Type Unspecified