Provider Demographics
NPI:1831169333
Name:NOBILIO-VICARIO, DEBORAH ANNE (MD)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:ANNE
Last Name:NOBILIO-VICARIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:ANNE
Other - Last Name:NOBILIO-VICARIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:10325 DEWHURST RD
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-8403
Mailing Address - Country:US
Mailing Address - Phone:440-414-9260
Mailing Address - Fax:216-201-5581
Practice Address - Street 1:10325 DEWHURST RD
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-8403
Practice Address - Country:US
Practice Address - Phone:440-414-9260
Practice Address - Fax:216-201-5581
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35075128207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHE75128OtherSUMMA
OH2219183Medicaid
OH000000184801OtherANTHEM
080167275OtherRAILROAD MEDICARE
OH2219183Medicaid
OHE75128OtherSUMMA