1083632749 NPI number — GREGORY G DANESIS MD

Table of content: GREGORY G DANESIS MD (NPI 1083632749)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083632749 NPI number — GREGORY G DANESIS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DANESIS
Provider First Name:
GREGORY
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083632749
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 W EXCHANGE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AKRON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44302-1709
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-535-4428
Provider Business Mailing Address Fax Number:
330-535-4451

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2651 W MARKET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRLAWN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44333-4230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-835-5584
Provider Business Practice Location Address Fax Number:
330-835-5591
Provider Enumeration Date:
07/18/2006

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: 208800000X , with the licence number:  35-053466 , 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: 9338635 . This is a "PARTNERS PHYSICIAN GROUP MEDICARE GROUP #" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1841239274 . This is a "PARTNERS PHYSICIAN GROUP TYPE 2 NPI #" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0822926 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2551671 . This is a "PARTNERS PHYSICIAN GROUP MEDICAID GROUP #" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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