Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 34.012938 | OH |
NPI | 1083039309 |
---|---|
Provider Name | Jamie Delvecchio |
First Address | Chardon, OH 44024-2909 |
Second Address | Chardon, OH 44024 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2014 |
Last Update Date | 30/10/2018 |