Basic Information
| Provider Information | |||||||||
| NPI: | 1720406994 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RICHARD D. SBROCCHI MD FACS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7640 SYLVANIA AVE | ||||||||
| Address2: | SUITE N | ||||||||
| City: | SYLVANIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435609729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198245063 | ||||||||
| FaxNumber: | 4198240216 | ||||||||
| Practice Location | |||||||||
| Address1: | 7640 SYLVANIA AVE | ||||||||
| Address2: | SUITE N | ||||||||
| City: | SYLVANIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435609729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198245063 | ||||||||
| FaxNumber: | 4198240216 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2014 | ||||||||
| LastUpdateDate: | 04/18/2014 | ||||||||
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| AuthorizedOfficialLastName: | SBROCCHI | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4195177575 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | 35052878 | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
No ID Information.