Doctor Name: | AMMIE MARAVELLI |
NPI Number: | 1174554794 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | |
Business Practice Address: | 667 Eastland Ave Se Warren, OH - 444844503 |
Business Phone Number: | 3308414029 |
Business Fax Number: | 3306565901 |
Mailing Address: | 5700 Darrow Rd, Suite 106 HUDSON |
State: | OH |
Postal Code: | 442365021 |
Phone Number: | 3306565911 |
Fax Number: | 3306565901 |
NPI Enumeration Date: | 07/05/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |