Provider Demographics
NPI:1053388892
Name:CEVASCO, ROBERT DANIEL JR (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:DANIEL
Last Name:CEVASCO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 E MARKET ST
Mailing Address - Street 2:PO BOX 3542
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44308-2038
Mailing Address - Country:US
Mailing Address - Phone:330-996-0347
Mailing Address - Fax:330-996-0359
Practice Address - Street 1:75 ARCH ST
Practice Address - Street 2:STE G2
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1429
Practice Address - Country:US
Practice Address - Phone:330-375-4100
Practice Address - Fax:330-375-4097
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35043548207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0433490Medicaid
0495453Medicare PIN
B96551Medicare UPIN