Provider Demographics
NPI:1366608218
Name:CIACCIA, SCOTT MARTIN (DO)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:MARTIN
Last Name:CIACCIA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5001 TRANSPORTATION DR STE 101
Mailing Address - Street 2:
Mailing Address - City:SHEFFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44054-2850
Mailing Address - Country:US
Mailing Address - Phone:440-329-2800
Mailing Address - Fax:440-329-2810
Practice Address - Street 1:5001 TRANSPORTATION DR STE 101
Practice Address - Street 2:
Practice Address - City:SHEFFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44054-2850
Practice Address - Country:US
Practice Address - Phone:440-329-2800
Practice Address - Fax:440-329-2810
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2638207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVWV1656AMedicare PIN
WVP01087440OtherRAILROAD MEDICARE
OH58.002311OtherOHIO TRAINING LICENSE NUMBER
WV3810023542Medicaid