Basic Information
| Provider Information | |||||||||
| NPI: | 1215936844 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MUCCIO | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6480 HARRISON AVE STE 201 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452477961 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5133543700 | ||||||||
| FaxNumber: | 5132462391 | ||||||||
| Practice Location | |||||||||
| Address1: | 8311 MONTGOMERY RD | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452362227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5133543700 | ||||||||
| FaxNumber: | 5132462391 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2005 | ||||||||
| LastUpdateDate: | 09/07/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 35-07-8499 | OH | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 2189886 | 05 | OH | MEDICAID | 200325580A | 05 | IN | MEDICAID |