1306948039 NPI number — PAMELA A PEROZENI PA-C

Table of content: PAMELA A PEROZENI PA-C (NPI 1306948039)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306948039 NPI number — PAMELA A PEROZENI PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEROZENI
Provider First Name:
PAMELA
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MILLER
Provider Other First Name:
PAMELA
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1306948039
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/26/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 951101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44193-0005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-879-0081
Provider Business Mailing Address Fax Number:
440-879-0084

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6000 LOMBARDO CTR STE 130
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEVEN HILLS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44131-6906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-478-9208
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/02/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  50-000705 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0068811 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".