Individual
DR. GRENVILLE JOACHIM MACHADO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2839 COPLEY RD, COPLEY, OH 44321
(330) 666-2022
(330) 665-9659
Mailing address
2839 COPLEY RD, COPLEY, OH 44321
(330) 666-2022
(330) 665-9659
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
68838
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000184866
ANTHEM BLUE SHIELD
OH
05
—
0186418
—
OH
01
—
176
SUMMACARE
OH
01
—
410908
WELLCARE OF OHIO INC
OH
01
—
729267
BUCKEYE COMMUNITY HEALTH
OH
Enumeration date
12/05/2005
Last updated
05/17/2008
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