Provider Demographics
NPI:1912104548
Name:DAVID AND JOHN DELLIQOADRI, D.O. INC
Entity Type:Organization
Organization Name:DAVID AND JOHN DELLIQOADRI, D.O. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:DELLIQUADRI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-545-8643
Mailing Address - Street 1:116 E LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:GIRARD
Mailing Address - State:OH
Mailing Address - Zip Code:44420-2648
Mailing Address - Country:US
Mailing Address - Phone:330-545-8643
Mailing Address - Fax:330-545-6557
Practice Address - Street 1:116 E LIBERTY ST
Practice Address - Street 2:
Practice Address - City:GIRARD
Practice Address - State:OH
Practice Address - Zip Code:44420-2648
Practice Address - Country:US
Practice Address - Phone:330-545-8643
Practice Address - Fax:330-545-6557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34002890207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0925299Medicaid
OHDEO467241Medicare ID - Type Unspecified
OHE00646Medicare UPIN