Provider Demographics
NPI:1912090291
Name:NEARY, JOHN PHILIP (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PHILIP
Last Name:NEARY
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 1:571 BOSTON MILLS RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-1112
Mailing Address - Country:US
Mailing Address - Phone:330-655-9700
Mailing Address - Fax:330-342-9847
Practice Address - Street 1:571 BOSTON MILLS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-1112
Practice Address - Country:US
Practice Address - Phone:330-655-9700
Practice Address - Fax:330-342-9847
Is Sole Proprietor?:No
Enumeration Date:2006-10-01
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.065469204E00000X
OH350654692082S0099X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0743902OtherPTAN
OH0743902OtherPTAN
OH9341719Medicare PIN