Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Dr. Theodore A Buccilli Jr., DPM

Individual provider Podiatrist · NPI 1164413019

Dr. Theodore A Buccilli Jr., DPM is a Podiatrist in Ravenna, Ohio. Practices as a sole proprietor. Licensed in Ohio.

Licensed in
OH
In the registry since
2005
What do these letters mean?
DPM — Doctor of Podiatric Medicine
A foot and ankle physician and surgeon.

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Practice location Address checks out

4403 Clover Dr
Ravenna, OH 44266-8636
Phone: (330) 687-7464
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Podiatrist (primary) Taxonomy 213E00000X · Licence 36003352 (OH)

Record details

NPI number1164413019
Entity typeIndividual (Type 1)
GenderMale
Credentials DPM
Sole proprietorYes
NPI enumeratedOctober 31, 2005
Last updated in NPPESAugust 15, 2025
Certification dateAugust 15, 2025

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